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When should one perform shockwave lithotripsy for lower caliceal stones?
1Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
Journal of Endourology
|December 1, 1995
Summary
Extracorporeal shockwave lithotripsy (SWL) is less effective for lower pole kidney stones compared to middle or upper pole stones. However, SWL may be a suitable conservative option for smaller lower pole stones due to its lower morbidity.
Area of Science:
- Urology
- Nephrology
- Medical Technology
Background:
- Lower caliceal stones present a treatment challenge due to difficulties in fragment passage after extracorporeal shockwave lithotripsy (SWL).
- Comparative outcomes of SWL for stones in different kidney calyces are crucial for treatment selection.
Purpose of the Study:
- To evaluate the efficacy of SWL monotherapy for lower pole kidney stones.
- To compare SWL outcomes for lower pole stones with those for middle and upper pole stones.
- To assess SWL effectiveness in relation to stone size and compare it with percutaneous nephrolithotomy (PCN).
Main Methods:
- Retrospective analysis of 219 patients undergoing SWL for lower pole stones.
- Comparison with SWL outcomes in 82 patients with middle pole and 85 patients with upper pole stones.
- Evaluation of stone-free rates based on stone size and comparison with literature data for PCN.
Main Results:
- SWL monotherapy achieved stone-free rates of 59% for lower pole, 77% for middle pole, and 64% for upper pole stones.
- For lower pole stones, SWL was unsuccessful in 41% of patients, with 9% having minimal residual stones.
- Stone-free rates for lower pole stones were 82% for sizes < 1 cm², 59% for 1-3 cm², 13% for 3-4.9 cm², and 0% for > 5 cm².
Conclusions:
- SWL monotherapy demonstrates variable efficacy for lower pole stones, with success rates decreasing significantly as stone size increases.
- For lower pole stones < 1 cm², SWL offers comparable results to PCN.
- Despite lower stone-free rates for moderate-sized lower pole stones (1-3 cm²), SWL's lower morbidity makes it an acceptable conservative option, particularly for patients preferring less invasive treatment.