Treatment of caliceal calculi

We analysed the course of 80 "stone periods" (the time that elapses between making a diagnosis and passage of a stone, operation, or an out-patient's last check-up) in 62 patients with caliceal stones prior to the development of extracorporeal shockwave lithotripsy (ESWL) and endourology. The observation time per patient averaged 7.4 years; 16% of the stones passed spontaneously and 40% were removed surgically. The infection rate was 68% and 45% of the stones increased in size during the observation period. Retrospective evaluation showed that of 32 patients who underwent surgery, only 11 procedures were performed at the appropriate time. In the remaining 21 cases the timing of surgery was judged to have been too late because of the ensuing complications. In 8 patients stone growth led to staghorn calculi, 8 had acute obstruction with incipient urosepsis, 3 had chronic urinary infection and 1 had loss of kidney function. We believe that 83% of all caliceal stones require intervention (ESWL or percutaneous nephrolithotomy) within 5 years of diagnosis. Only 11% of patients with caliceal calculi remain symptom-free after 10 years.