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Efficacy of the lithotripsy in treating lower pole renal stones

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Abstract

Use of extracorporeal lithotripsy is declining in North America and many European countries despite international guidelines advocating it as a first-line therapy. Traditionally, lithotripsy is thought to have poor efficacy at treating lower pole renal stones. We evaluated the success rates of lithotripsy for lower pole renal stones in our unit. 50 patients with lower pole kidney stones ≤15 mm treated between 3/5/11 and 19/4/12 were included in the study. Patients received lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter according to a standard protocol. Clinical success was defined as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) ≤3 mm at radiological follow-up. The mean stone size was 7.8 mm. The majority of stones (66 %) were between 5 and 10 mm. 28 % of stones were between 10 and 15 mm. For solitary lower pole stones complete stone clearance was achieved in 63 %. Total stone clearance including those with CIRFs was achieved in 81 % of patients. As expected, for those with multiple lower pole stones the success rates were lower: complete clearance was observed in 39 % and combined clearance including those with CIRFs was 56 %. Overall, complete stone clearance was observed in 54 % of patients and clearance with CIRFs was achieved in 72 % of patients. Success rate could not be attributed to age, stone size or gender. Our outcome data for the treatment of lower pole renal stones (≤15 mm) compare favourably with the literature. With this level of stone clearance, a non-invasive, outpatient-based treatment like lithotripsy should remain the first-line treatment option for lower pole stones. Ureteroscopy must prove that it is significantly better either in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.

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Acknowledgments

We would like to thank Jackie Redgwell, Fiona Barber, Mandy Spencer and Paul Martin for help with collection of data for this study and delivering the lithotripsy service.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. The Oxford Stone Group, The Churchill Hospital, Oxford, OX3 7LF, UK

    Helen Cui, Eeke Thomee, Jeremy G. Noble, John M. Reynard & Benjamin W. Turney

  2. Department of Urology, Nuffield Department of Surgical Sciences, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, UK

    Helen Cui

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  1. Helen Cui
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  2. Eeke Thomee
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Correspondence to Helen Cui.

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Cui, H., Thomee, E., Noble, J.G. et al. Efficacy of the lithotripsy in treating lower pole renal stones. Urolithiasis 41, 231–234 (2013). https://doi.org/10.1007/s00240-013-0549-8

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