Clearance of Lower-Pole Stones following Shock Wave Lithotripsy: Effect of the Infundibulopelvic Angle

Keeley, Francis X.; Moussa, Sami A.; Smith, Gordon; Tolley, David A.

doi:10.1159/000020016

Cited by 76 publications

(31 citation statements)

References 21 publications

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“…However, in our study no significant relationship could be established between the outcome and the stone burden. From this aspect, our data collaborates with the findings of Ghoneim et al, Keeley et al, Madbouly et al, and Sahinkanat et al (15,16,24,31). This may be ascribed to our small cohort.…”

Section: Discussionsupporting

confidence: 93%

The efficacy of radiographic anatomical measurement methods in predicting success after extracorporeal shockwave lithotripsy for lower pole kidney stones

Arpalı¹,

Altınel

Sargin³

2014

Int. braz j urol.

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ARTICLE INFO ______________________________________________________________ ______________________Objectives: To assess the impact of lower pole calyceal anatomy on clearace of lower pole stones after extracorporeal shockwave lithotripsy (ESWL) by means of a new and previously defined radiographic measurement method. Materials and Methods:Sixty-four patients with solitary radiopaque lower pole kidney stones were enrolled in the study. Infundibulopelvic angle (IPA), infundibulotransverse angle (ITA), infundibular lenght(IL), and infundibular width (IW) were measured on the intravenous urographies which were taken before the procedure. Results: 48 of 64 patients (75%) were stone-free after a follow-up period of 3 months. The IPA,ITA,IL and IW were determined as statistically significant factors, while age,gender and stone area were found to have no impact on clearance. Conclusion: By the help of radiographic measurement methods related to lower pole kidney anatomy, appropriate patient selection and increment in success after ESWL may be achieved.

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Section: Discussionsupporting

confidence: 93%

The efficacy of radiographic anatomical measurement methods in predicting success after extracorporeal shockwave lithotripsy for lower pole kidney stones

Arpalı¹,

Altınel

Sargin³

2014

Int. braz j urol.

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“…Overall stonefree rates for PCNL were far superior to that of SWL (95% v. 37%), retreatments were more common in the SWL group (16% v. 9%) and auxillary procedures were more frequent with SWL patients (16% v. 2%). Stratification by stone size was also consistent with prior studies [7][8][9] demonstrating SWL stone-free rates of 68% for stones smaller than 10 mm in diameter, 55% for stones 10-20 mm and 29% for stones larger than 20 mm. The corresponding stone-free rates for PCNL were 100%, 93% and 86%, demonstrating that, for PCNL, stone-free rates are largely independent of stone size.…”

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confidence: 87%

Percutaneous nephrolithotomy for the treatment of lower pole renal calculi

Al-Bareeq

Denstedt

2008

CUAJ

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Point / Counterpoint T he management of lower pole renal stones continues to evoke debate, and the ideal treatment remains controversial although several comparative studies have been conducted to evaluate various approaches. In an Internet and postal survey of 205 urologists, 88% preferred shock wave lithotripsy (SWL) for lower pole stones smaller than 10 mm in diameter, 65% for stones between 10 and 20 mm and 21% for stones greater than 20 mm.1 Current practice, however, may not reflect the efficacy of any particular modality. Lower pole calyceal stones continue to pose a dilemma owing to the dependent anatomical location and difficulty in clearance of stone fragments. Sampaio and Aragao 2 first described the anatomical factors that would impede gravity-dependent drainage of stones from the lower pole calices. By performing endocasts of the collecting system of cadaveric kidneys, this group postulated that the infundibulopelvic angle, infundibular length and spatial distribution of the lower pole calices all represented potential contributing features in the equation related to stone clearance. Sampaio and colleagues 3 conducted a prospective trial to determine stone-free rates after SWL, aligned to these anatomical features. They found that 72% of patients were rendered stone-free when the lower pole infundibulopelvic angle was greater than 90 degrees, and only 23% of patients achieved a stone-free state when the angle was less than 90 degrees. Although SWL is less invasive, its limitations for lower pole calculi are outlined in an earlier study by McDougall and associates 4 that retrospectively compared SWL to percutaneous nephrolithotomy (PCNL) for patients with lower pole stones. Overall, there was a significantly lower stone-free rate in patients treated with SWL (56%) compared with the stone-free rate of those undergoing PCNL (85%).Lingeman and coworkers 5 conducted an analysis comparing the 2 modalities including outcomes of more than 3000 patients treated with SWL and 100 with PCNL. Stone-free rates for PCNL were significantly higher (90%) compared with SWL (59%). The authors recommended SWL as a first-line treatment for lower pole calculi measuring 10 mm or less in diameter and PCNL for larger stones. These retrospective studies formed the basis for a multicentre lower pole study group, 6 which conducted the first prospective randomized trial with the aim of determining the optimal treatment of lower pole calculi. The group compared stone-free rates in 52 patients undergoing SWL and 55 randomized to PCNL. Overall stonefree rates for PCNL were far superior to that of SWL (95% v. 37%), retreatments were more common in the SWL group (16% v. 9%) and auxillary procedures were more frequent with SWL patients (16% v. 2%). Stratification by stone size was also consistent with prior studies [7][8][9] demonstrating SWL stone-free rates of 68% for stones smaller than 10 mm in diameter, 55% for stones 10-20 mm and 29% for stones larger than 20 mm. The corresponding stone-free rates for PCNL were 100%, 93% an...

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“…Proper assessment of lower caliceal features seems to be a particular problem because several authors described different methods (6,16,17). A recent study showed that there were high interobserver variations among different techniques (18).…”

Section: Discussionmentioning

confidence: 99%

The impact of pelvicaliceal anatomical variation between the stone-bearing and normal contralateral kidney on stone formation in adult patients with lower caliceal stones

et al. 2006

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Objective: We aimed to investigate the effect of pelvicaliceal anatomical differences on the etiology of lower caliceal stones. Materials and Methods: Records of adult patients between January 1996 and December 2005 with solitary lower caliceal stone were reviewed. After exclusion of patients with hydronephrosis, major renal anatomic anomalies, non-calcium stones, history of recurrent stone disease and previous renal surgery, 78 patients were enrolled into the study. Lower pole infundibulopelvic angle (IPA), infundibulovertebral angle (IVA), infundibular length (IL), width (IW), number of minor calices and cortical thickness of the lower pole together with other caliceal variables obtained from the whole pelvicaliceal anatomy of both stone-bearing and contralateral normal kidneys were measured from intravenous pyelogram of the patients. Total pelvicaliceal volume was also calculated by a previously described formula for both kidneys. Results: There were statistically significant difference between two kidneys in terms of IW (p < 0.001) and IL (p = 0.002) of the upper calyx, IW (p = 0.001) and IVA (p < 0.001) of the lower calyx), pelvicaliceal volume (p < 0.001), IPA of middle calyx (p = 0.006) and cortical thickness over the lower pole (p < 0.001). However there was no difference between stonebearing and contralateral normal kidneys in terms of lower pole IPA (p = 0.864) and IL (p = 0.568). Conclusion: Pelvicaliceal volume but not lower caliceal properties seem to be a risk factor for stone formation in lower calyx.

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Clearance of Lower-Pole Stones following Shock Wave Lithotripsy: Effect of the Infundibulopelvic Angle

Cited by 76 publications

References 21 publications

The efficacy of radiographic anatomical measurement methods in predicting success after extracorporeal shockwave lithotripsy for lower pole kidney stones

The efficacy of radiographic anatomical measurement methods in predicting success after extracorporeal shockwave lithotripsy for lower pole kidney stones

Percutaneous nephrolithotomy for the treatment of lower pole renal calculi

The impact of pelvicaliceal anatomical variation between the stone-bearing and normal contralateral kidney on stone formation in adult patients with lower caliceal stones

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