alexa Extracorporeal shock wave lithotripsy for lower pole calculi: long-term radiographic and clinical outcome.


Medical & Surgical Urology

Author(s): Chen RN, Streem SB

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Abstract PURPOSE: We evaluated the efficacy of extracorporeal shock wave lithotripsy (ESWL) for lower pole calculi regarding immediate and long-term radiographic and clinical outcomes. MATERIALS AND METHODS: A total of 206 patients with isolated lower pole calculi in 220 renal units underwent ESWL for stones 4 to 625 mm2 (mean 88). Clinical and radiographic followup was obtained at 1 month and every 6 to 12 months thereafter. An initial stone-free rate was determined, as was the subsequent radiographic outcome. Clinical outcome with regard to a symptomatic episode or requiring intervention was also determined. Kaplan-Meier estimates of the probabilities of these outcomes with time were developed. RESULTS: Of the 206 patients 99 (48\%) were rendered stone-free by 1 month after ESWL. Another 13 patients (6.3\%) spontaneously became stone-free within another 1 to 95 months (mean 17.5). Of the remaining patients residual stones were decreased, stable or increased in 13 (6.3\%), 71 (34\%) and 10 (4.8\%), respectively, after 1 to 91 months (mean 14.5). Among all 206 patients 180 (87.4\%) remained asymptomatic for 1 to 99 months, while 7 (3.4\%) suffered a symptomatic episode requiring medical attention 1 to 40 months (mean 21.1) after ESWL and 19 (9.2\%) required intervention after 1 to 91 months (mean 23.9). Kaplan-Meier estimates of the probabilities of a symptomatic episode or requiring intervention at 5 years were 0.24 and 0.52, respectively. CONCLUSIONS: ESWL is the initial treatment of choice for lower pole calculi smaller than 2 cm.2 because the stone-free rate is comparable to that for stones at other caliceal locations and, perhaps more importantly, the risk of a symptomatic episode or requiring secondary intervention is low even in the setting of residual fragments.
This article was published in J Urol and referenced in Medical & Surgical Urology

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