Does Lower-Pole Caliceal Anatomy Predict Stone Clearance after Shock Wave Lithotripsy for Primary Lower-Pole Nephrolithiasis?

Abstract

Aim: In order to have an idea about the success rates after extracorporeal shock wave lithotripsy (SWL) in patients with lower-pole stones, we reviewed the caliceal anatomy of the patients treated in our clinic. Patients and Methods: One hundred and ninety-eight patients having at least a 3-month follow-up period, with a single stone located in the lower pole, were included. Lower infundibulopelvic angle (LIP-A), infundibular width, and infundibular length were measured from standard intravenous urograms taken before initial ESWL. Results: One hundred and thirty patients (65%) were male, and 68 patients (35%) were female. We found no impact of age, sex, and affected side on the results of ESWL. The overall stone-free rate was 61.1% after 3 months of follow-up. The stone-free rates were 47.8 and 81.4% in patients with an acute (<70°) and an obtuse (≧70°) LIP-A, respectively (p = 0.007). Taking the infundibular width into consideration, the stone-free rates were 85.4 and 43.2% for favorable and unfavorable angles and widths (p = 0.003). However, infundibular length and stone sizes were not found to have important effects on a stone-free status (p = 0.546 and p = 0.283). Conclusion: We conclude that LIP-A (≧70°) has the greatest impact on the clearance of residual fragments produced by SWL.

Pediatric Extracorporeal Shock Wave Lithotripsy: Multi-Institutional Results

“…Another limitation was in evaluating children; no standard imaging was used and CT was avoided because of the potential risk that was discussed above. As it was reported, many factors such as calyceal anatomy, lower infundibulopelvic angle, infundibular length and diameter, could be predictive of stone-free rates for calyceal stones, which were all overlooked in that study (21)(22)(23). Finally, it was a retrospective study and some data could not be retrieved from several centers.…”

The factors that affecting shockwave lithotripsy treatment outcome of kidney stones

“…In the study conducted by Talas et al on 198 patients, the IA was reported to be one of the essential factors in the removal of residual stone fragments after SWL in lower calyx kidney stones. 17 In the retrospective study conducted by Viswaroop et al on 148 patients, it was revealed that the IA did not have a significant relationship with the success of treatment in the lower calyx stones 10 mm and above. 18 Similarly, our results yielded that the IA did not affect SWL success.…”

Can we predict the ancillary treatments after extracorporeal shockwave lithotripsy for renal and upper ureteral stones?

“…On multivariate analysis, it was found that stone multiplicity, stone location and HU were independent significant predictors for the treatments after SWL (p values < 0.05) (Table 2). Table 3 summarizes SWL contemporary series tracking the required auxiliary procedures after SWL and predictors of SWL failure (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”