Extracorporeal Shock Wave Lithotripsy Monotherapy for Staghorn Calculi

Abstract

maximum length on plain X-rays were treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy for a period of 2 years. Thirty patients, with a follow-up of more than 6 months after the last treatment, were included in this study. The surface area of the calculi was 1,290 mm^2 on average. Based on plain X-rays, 9 cases (30%) became free of calculi while 12 patients (40%) had a small amount of residual fragments (less than 100 mm2 in area). Adding these cases to those in which all the residual calculi were eliminated, the total turned out to be 21 cases (70%) and the treatment of staghorn calculi with ESWL was thus considered to have been fairly effective in the present series. The remaining 9 cases (30%) contained a considerable amount of residuals (more than 100 mm2). The present study in the ESWL of large staghorn calculi revealed no clear relationship between the surface area of the stones and evacuation of the fragments. The amount of the residual fragments was significantly small when either the renal collecting system was less than 2,000 mm^2 in area (p < 0.05), or when the ureteropelvic junction (UPJ) was equal or greater than 5 mm in diameter (p < 0.02) according to intravenous pyelography (IVP) before treatment. The complications associated with this treatment were minimal, with a high fever in only 3 patients that were treated easily by antibiotic therapy. ESWL monotherapy thus appears to be effective for the treatment of staghorn calculi, while causing few complications. Thus, cases showing less than 2,000 mm^2 in area for the collecting system or those showing an equal to or greater than 5 mm diameter of UPJ on IYP before treatment, are all thought to be good candidates for ESWL monotherapy.

Solitary Kidney Stone Treatment by Extracorporeal Shock Wave Lithotripsy

“…For renal calculi of <400 mm2 (600 renal units) the success rate was 87%, and for upper ureteral stones (175 renal units) 85%. These results strongly corroborate the results of some other authors [5,7,12,13].…”

“…More than 90% of the stones can be disintegrated and 70% completely eliminated 3 months after lithotripsy [4], Yet, for large, especially staghorn stones, the combined approach (percutaneous nephroli tholapaxy and ESWL) is generally recommended. Nev ertheless, some lithotripsy centers have also reported quite good results with ESWL monotherapy [5][6][7][8][9][10], Ob viously, ESWL monotherapy treatment of staghorn stones, even in patients with 2 good functioning kidneys, brings substantial risk of complications, first of all frag ment obstruction. In solitary kidney stones, especially staghorn stones, the risk of obstruction and consecutive anuria could be one more reason for this treatment com bination.…”

“…Encouraging results with ESWL monotherapy of staghorn stones have already been achieved in our lithotripsy center (in patients with 2 functioning kidneys) [11], as well as in some other lithotripsy centers [5][6][7][8][9][10], This has had a decisive influence on our attempt to treat such urolithiases only with ESWL, to analyze the results achieved and evaluate whether this form of treatment is appropriate or not.…”

Strategic lithotripsy using the Doli S EMSE 220 F-XP for the management of staghorn renal calculi

“…Di Silverio et al [10] suggested that SWL monotherapy should be recommended in patients with no dilatation of renal pelvis or calyces. Some authors also reported that the efficacy of treatment has more to do with the size of the pelvis and calyces, as well as the diameter of the ureteropelvic junction than with the size of the calculi [3,11,12]. It seems that there is much controversy regarding the factors predicting the outcome of SWL monotherapy for the management of staghorn calculi.…”