Comparative Results Of Shockwave Lithotripsy For Renal Calculi In Upper, Middle, And Lower Calices

Main Category: Urology / Nephrology
Article Date: 30 Dec 2007 - 1:00 PDT

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UroToday.com- Using a Dornier MPL 9000, the authors provide a very thorough evaluation of treatments among 118 patients with solitary calyceal stones. Stone free was defined as < 3 mm on an intravenous urogram at 3 months. There is not much new here but it reinforces earlier works with the following observations:

a. Lower calyceal stones clear poorer than middle or upper calyceal calculi: 83%, 83%, and 68%. Of particular importance is that while these numbers look "good" at first glance, the efficiency quotients (i.e. % of stones requiring a single treatment without the attendant need for either retreatment or an auxiliary procedure) tell another story: 50%, 45%, and 33% respectively.

b. While calculi up to 2 cm can be treated, the success rate is less than for stones in the 1 cm or less range: 91% vs. 66% with an attendant increase in the mean number of treatment sessions from 1.9 to 2.4 (i.e. read: diminishing returns).

c. In this study, lower pole infundibular length and width were statistically significantly related to treatment success. However, this remains an ongoing controversial point of diminishing relevance given the demise of intravenous urography in the United States.

In sum, shock wave lithotripsy in 2007, in my opinion, likely is best reserved for those calculi up to 1 cm in size, with those stones larger than 2 cm being relegated to percutaneous procedures. For the stones in between 1-2 cm other factors such as location, density on CT scan, and the skin to stone distance should be considered in the decision making process for shock wave lithotripsy vs. ureteroscopy vs. percutaneous stone removal.

Turna B, Ekren F, Nazli O, Akbay K, Altay B, Ozyurt C, Cikill N

J Endourol. 21(9):951-956, September 2007
doi:10.1089/end.2007.0275.

Reported by UroToday.com Contributing Editor Ralph V. Clayman, M.D

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