Jens Rassweiler, MD, Professor and Head of the Department of Urology at Klinikum Heilbronn, the academic hospital of Heidelberg University in Germany, discusses the management of complicated cases of endourological stones. First, he defines what exactly makes a case complicated, and then goes on to detail the procedures involved. He compares various management methods, noting the pros and cons of each and emphasizing the importance of staying away from open surgery when possible. He does discuss the best techniques for open surgery when it is unavoidable, but emphasizes that a combination of robotic and laparoscopic surgery is best.