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[Renoureteral malformation and lithiasis. Therapeutic approach]
A Fernández Rodríguez1, M Arrabal Martín, J L Miján Ortiz
1Servicio de Urología, Hospital Universitario San Cecilio, Granada, España.
Objective:
To analyze our results in the treatment of calculi in renoureteral malformations with extracorporeal shock wave lithotripsy (ESWL) alone and the efficacy of ESWL and adjuvant methods in the resolution of calculi in different types of renoureteral malformations.
Methods:
The study comprised 141 cases of renoureteral malformations with urinary calculi; 68 were renal, 69 ureteral and 4 in the Bricker urinary diversion. All patients had been diagnosed by IVP and treated by ESWL. These patients were compared with a control group of 125 patients with calculi and a normal renoureteral system that were treated similarly.
Results:
The malformations accounted for 2.61% of the 5,400 patients that had been treated in our unit from 1990-1998. The mean number of sessions for the patients with malformations was 1.5 versus 1.2 for the control group. The results of treatment were significantly lower for the group of patients with renal malformations than for the control group (54% vs. 87.2%, respectively). Similar results were obtained for the group of patients with ureteral malformations and the control group (87% vs. 75%).
Conclusions:
ESWL can be the first treatment option for calculi in patients with renal malformations, although they should be individually evaluated for status of the excretory system, urinary flow dynamics and size of the calculus in order to select the best treatment option. In patients with ureteral malformations, the same criteria utilized for those with a normal excretory system should be applied.