Calyceal stones: fate of shock wave therapy with respect to stone localization

In a retrospective analysis the results of extracorporeal shock wave lithotripsy (ESWL) treatment were evaluated in patients with renal stones according to calyceal localization of treated stones. The 198 patients who underwent ESWL with the Dornier MPL 9000 were analyzed for success rate, complication rate, residual fragments, regrowth and recurrence rates. Totally 210 calyceal calculi located in different portions of the kidney have been comparatively evaluated. No major complications were noted during or after ESWL. Some minor complications such as flank pain, renal colic, haematuria were observed. Flank pain was observed during ESWL treatment especially in patients with upper calyceal stones. Although stone-free and residual fragment rates were similar in pelvic, upper and middle calyces, patients with lower calyceal and pelvicalyceal stones had high residual fragment rate and lower stone-free rate. Patients with stones in the lower calyces or pelvicalyces had high recurrence and regrowth rates (p < 0.05). ESWL has been considered as the optimal treatment modality for most upper urinary tract calculi. It is especially effective in patients with pelvic, upper and middle calyceal stones. Patients with lower calyceal stones often failed to eliminate the fragments, hence had high recurrence and regrowth rates.