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Clinical significance of residual fragments in 2015: impact, detection, and how to avoid them

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Abstract

Purpose

Residual fragments are common after stone treatment. Little is known about clinical outcomes relevant to the patient. This comprehensive review of the literature highlights the impact of residual fragments, modes of detection, and treatment strategies to avoid residual fragments in shock wave therapy, ureteroscopy, and percutaneous nephrolithotomy.

Methods

A comprehensive review of current literature was performed using PubMed®, MEDLINE®, Embase™, Ovid®, Google Scholar™, and the Cochrane Library. Publications relevant to the subject were retrieved and critically appraised.

Results

Residual fragments after treatment for urinary stones have a significant impact on a patient’s well-being and future course. (Ultra-) low-dose non-contrast computed tomography detects small residuals most reliably. In shock wave lithotripsy, adherence to basic principles helps to improve results. Various techniques and devices facilitate complete stone clearance in conventional and miniaturized percutaneous nephrolithotomy and (flexible) ureteroscopy. Promising new technologies in shock waves, lasers, and robotics (and potentially microrobotics) are on the horizon.

Conclusions

Residual fragments are relevant to patients. Contemporary treatment of urolithiasis should aim at complete stone clearance.

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Abbreviations

AUA:

American Urological Association

BWL:

Burst wave lithotripsy

CIRF:

Clinically insignificant residual fragment(s)

CT:

Computed tomography

EAU:

European Association of Urology

fURS:

Flexible ureteroscopy

IVU:

Intravenous urography

KUB:

Kidney ureter bladder

LISL:

Laser-induced shock wave lithotripsy

NCCT:

Non-contrast computed tomography

PDI:

Percussion, diuresis, and inversion

PNL:

Percutaneous nephrolithotomy

RF:

Residual fragment(s)

SFR:

Stone-free rate

SWL:

Extracorporal shock wave therapy

US:

Ultrasonography

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Acknowledgments

The author received financial support from the Medical Faculty of the University Freiburg.

Authors’ contribution

S. Hein and M. Schoenthaler were acknowledged for protocol/project development, data collection and management, data analysis, manuscript writing/editing. A. Miernik contributed to protocol/project development, manuscript writing/editing, and supervision. K. Wilhelm helped in protocol development, data collection and management, and data analysis. F. Adams and D. Schlager were helpful in data collection and management and data analysis. T.R.H. Herrmann and J. Rassweiler helped with data interpretation and supervision.

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Correspondence to Arkadiusz Miernik.

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Arkadiusz Miernik: consultant contract with Schoelly GmbH, Denzlingen, Germany. Thomas R. W. Herrmann: Declares Karl Storz GmBH, Honoraria, financial Support for attending Symposia, financial support for educational programs, Consultancy, Advisory, Royalties; Boston Scientific AG Honoraria, financial support for attending Symposia, financial support for educational programs, Consultancy, Advisory Board; LISA Laser OHG AG Honoraria, financial support for attending Symposia, financial support for educational programs; Ipsen Pharma Honoraria, financial support for attending Symposia, Advisory Board. Martin Schoenthaler: consultant contract with Schoelly GmbH, Denzlingen, Germany, and NeoTract Inc., Pleasanton, USA. Other authors declare that they have no conflict of interest.

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Hein, S., Miernik, A., Wilhelm, K. et al. Clinical significance of residual fragments in 2015: impact, detection, and how to avoid them. World J Urol 34, 771–778 (2016). https://doi.org/10.1007/s00345-015-1713-2

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