Assessing the efficiency of extracorporeal shockwave lithotripsy for stones in renal units with impaired function: a prospective controlled study

Abstract

The objective was to determine the efficiency of extracorporeal shockwave lithotripsy (ESWL) in clearing stones from renal units with impaired function. Thirty-five patients with poorly functioning kidneys determined by intravenous urogram and 99mtechnetium diethylene triamine pentacetic acid renal dynamic scan underwent ESWL. Stone clearance was assessed at 3 months and compared with that in normally functioning kidneys. The study group was divided into two subgroups. Those with split glomerular filtration rate (GFR) of the concerned kidney between 10 and 20 ml/min were in group 1. Group 2 consisted of patients with split GFR between 20 and 30 ml/min. A control group (group 3) was formed from patients with urolithiasis and normally functioning kidneys. The overall retreatment rate was 84.4%. The overall stone clearance rate in the study group was 34.2% while it was 57.7% in the control group. The stone clearance rate in group 2 was 40%. The difference in stone clearance rate between the study and control groups was statistically significant (P=0.023) but that between group 2 and the control group was not (P=0.159). The incidence of steinstrasse between the study group 2 and control group was not statistically significant (P=0.408). The clearance rate for ureteral stones was comparable in all the three groups. The stone-free rate and rate of steinstrasse for renal stones in kidneys with moderately impaired function were comparable to normally functioning kidneys. However, kidneys with severely impaired function had poor results. The clearance rate for ureteral stones was not influenced by the impairment of renal function.

Noninvasive management of obstructing ureteral stones using electromagnetic extracorporeal shock wave lithotripsy

“…In published series, the stone-free rate after SWL is considered the main end point of all the experiences, without concern about renal function that can be adversely affected by hydronephrosis. Srivastava et al [13] described the role of ESWL in renal units with impaired function, concluding that SWL outcomes are comparable with those found in normal renal units.…”

Impact of Sleep Position on Stone Clearance after Shock Wave Lithotripsy in Renal Calculi

“…Fernandez Rodriguez et al [9] performed a multivariate analysis of 698 randomly selected patients who underwent SWL; the success rate decreased significantly with reduced GFR. Lee et al [5] and Srivastava et al [6] found that SWL is less successful in patients with decreased renal function. Schwartz et al [7] showed that body position has a significant effect on renal perfusion measured by nuclear renal scintigraphy.…”

“…The overall success rate of SWL was 88.3% (77. 4 [5] demonstrated that adequate urine production is essential for stone clearance after SWL and that the efficacy of SWL is compromised in patients with renal insufficiency and high creatinine [5,6].…”

Effects of renal parenchymal volume and total renal volume on success in retrograde intrarenal surgery

“…In RIRS procedure, the stones are divided into small pieces by laser aiming to take advantage of spontaneous drainage with diuresis that helps stone free state of kidney (3). Various studies in the literature indicate the importance of diuresis for the drainage of fragments after SWL (4,5). According to the study of Koc et al, measurement of renal parenchyma thickness (RPT) is a cost-effective method that can be easily performed on routinely applied non-contrast computerized tomography (CT) and may have predictive value for the surgical success in patients with nephrolithiasis.…”