Extracorporeal Shock Wave Lithotripsy for Lower Caliceal Calculi

Küpeli, Bora; Biri, Hasan; Sınık, Zafer; Karaca, Kani; Tuncayengin, Alper; Karaoğlan, Üstünol; Bozkırlı, İbrahim

doi:10.1159/000019713

Cited by 32 publications

(18 citation statements)

References 17 publications

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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.…”

supporting

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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supporting

confidence: 87%

Percutaneous nephrolithotomy for the treatment of lower pole renal calculi

Al-Bareeq

Denstedt

2008

CUAJ

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“…reported an overall SFR of 53% with SWL for inferior caliceal stone, 62% for sones of >1 cm, and 48% for 1-2 cm stones. [24] May and Chandhoke reported SFR of 75% for stones >2 cm after SWL. [25]…”

Section: Methodology Of Reviewmentioning

confidence: 99%

Management of 1-2 cm renal stones

Srivastava

Chipde

2013

Indian J Urol

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Introduction:The preferred treatment of >1cm stone is shockwave lithotripsy (SWL), while that of stone <2 cm is percutaneous nephrolithotomy (PCNL), but treatment of 1-2 cm renal stones is a controversial issue. We searched the literature to present a comprehensive review on this group.Material and Methods:Pubmed search of literature was done using the appropriate key words. We separately discussed the literature in lower polar and non lower polar stone groups.Results:For non lower polar renal stones of 1-2 cm, SWL is preferred approach, while for the lower polar stones; literature favors the use of PCNL. Retrograde intrarenal surgery (RIRS) is emerging as a promising technique for these calculi.Conclusions:Treatment of renal stone disease depends on stone and patient related, as well as on renal anatomical factors. Treatment should be individualized according to site of stone and available expertise.

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“…Renal colic is quite common (59) and pyelonephritis may also occur. Significant long-term effects of renal injury from SWL have not yet been shown to occur with any frequency; nevertheless, research into potential delayed effects of SWL, such as development or acceleration of hypertension, continues.…”

Section: Shockwave Lithotripsymentioning

confidence: 99%

Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

Marcovich

Smith

2003

Int. braz j urol.

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Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

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Extracorporeal Shock Wave Lithotripsy for Lower Caliceal Calculi

Cited by 32 publications

References 17 publications

Percutaneous nephrolithotomy for the treatment of lower pole renal calculi

Percutaneous nephrolithotomy for the treatment of lower pole renal calculi

Management of 1-2 cm renal stones

Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

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