Renal Stone Fragments Following Shock Wave Lithotripsy

Abstract

Purpose: We describe a select group of asymptomatic patients w i t h fragments a n d dust 3 months after extracorporeal treatment, who were followed t o evaluate the long-term outcome and therapeutic implications.Materials a n d Methods: A total of 129 patients with dust and residual fragments (less than 4 mm.) at 3 months w a s re-examined at 12 months, and 95 were also evaluated at 2 4 months. Followup examinations consisted of radiographic studies, renal ultrasonography and urine culture. D u s t a n d residual fragments were sought, and patients were defined as free or as h a v i n g persistent lithiasis or stone regrowth. At 24 m o n t h s recurrences in the patients stone-free at 1 2 months also were considered.Results: At the 12-month followup 60 patients (46.5%) were stone-free and 56 (43.5%) still had dust o r residual fragments. The localization of the stones o r fragments at 3 m o n t h s a n d their sizes did not have a significant influence on the stone-free rate but regrowth was greater in patients with stones larger t h a n 1 0 mm. (11 of 40 patients, 27.5% versus 2 of 89,2.2%, p = 0.001). The probability of eliminating residual lithiasis at 12 m o n t h s w a s significantly greater in patients with dust than in those with residual fragments ( 4 2 of 79 patients, 58% versus 18 of 50, 36%, p = 0.026). Regrowth of residual lithiasis w a s observed in 13 patients (10%).Conclusions: Based on o u r results, we do not believe that patients with fragments require systematic re-treatment in the short term but t h e y m a y be followed long t e r m and re-treated if symptoms persist or stones recur.KEY WORDS: extracorporeal shockwave lithotripsy, calculiThe therapeutic efficacy of shock wave lithotripsy in the treatment of renal and ureteral stones is undisputed 15 years after its introduction in clinical practice.' This method represents a revolution in the management of patients with lithiasis.2 However, since the first large series was presented, evaluation of the results of extracorporeal treatment has been controversial. Still more controversial is the approach to patients whose stones are not completely eliminated but in whom small fragments (less than 5 mm.) or dust persists, defined by some authors as clinically insignificant residual fragments.3-7 Such fragments are found at the renal level in 851c of patients at discharge after extracorporeal treatment, and are considered a factor that favors progression of lithiasis,R.g and an increased risk for significant symptomatic episodes or need for intervention.10 We describe a select group of asymptomatic patients with fragments and dust 3 months after extracorporeal treatment, who were followed to evaluate the long-term outcome and therapeutic implications. PATIENTS AND METHODSFor this study we considered 467 patients who underwent treatment with Dornier HM3 modified and MPL 9000 lithotriptors for a single radiopaque renal stone 15 mm. or less between 1991 and 1994. Other selection criteria were the absence of morphological alterations of the ...

The Role for Active Monitoring in Urinary Stones: A Systematic Review

“…6,[40][41][42][43][44][45][46][47][48] For a mean follow-up range between 6 and 57 months, spontaneous stone passage was noted in 11% to 92.7% of cases. The spontaneous clearance rate was highest for stones that were located in the ureter and lowest for the lowerpole stones.…”

“…Follow-up schedules are difficult to design because the tests and the intervals necessary were not specifically recorded in the majority of these studies. 39,[41][42][43]46,47,49 When described, standard follow-up comprised clinical examination, urine culture, radiographic studies, and=or renal ultrasonography at 3, 40,45 6, 6,40,48 or 12 6,44 month intervals. Such an intense follow-up, however, may not be indicated.…”

Prädiktion der Steinfreiheit nach extrakorporaler Stoßwellenlithotripsie bei unteren Nierenkelchsteinen

“…Fine et al [19], Streem et al [57] und Zanetti et al [65] zeigten, dass Patienten mit kleinen Residualfragmenten nach ESWL häufiger unter Nierenkoliken und erneutem Steinwachstum leiden. Gerade wegen dieser Fälle wurde die Benutzung des Begriffs "klinisch insignifikante Residualfragmente" in diesen Arbeiten in Zweifel gestellt.…”

Value of Ultrasonography and Helical Computed Tomography in the Diagnosis of Stone-Free Patients after Extracorporeal Shock Wave Lithotripsy (USG and Helical CT after SWL)

“…If we consider the SWL results of ureteral stones, residual stones are detected in 30% of the cases and 22-37% of them needs to be re-evaluated [8]. Zanetti et al [8] followed 129 patients with 4 mm.…”

“…Zanetti et al [8] followed 129 patients with 4 mm. or less residual fragments following SWL and noted that 25 became symptomatic or required further treatment within 2 years of lithotripsy.…”