Multistaged Extracorporeal Shock Wave Lithotripsy Monotherapy for Large Renal Calculi
From 1985 to 1988 2,200 patients were treated by extracorporeal shock wave lithotripsy (ESWL*). Among these patients 97 were harboring large renal calculi; some of which were branched. Renal stones were considered large when they exceeded 30 mm in diameter, the average stone size for the 97 patients was 49 mm (range, 30 mm to 110 mm). Staged ESWL monotherapy was planned to avoid the percutaneous debulking of such calculi. The idea was to eliminate stone fragments in three stages with a one-month interval between each treatment, thereby avoiding the possibility of ureteric obstruction and fever. Double-pigtail stents were inserted pre-ESWL in only 25 patients. In the group without stents (Group I), there were 72 patients. Of these, 63 (87%) became stone free within three months without any post-ESWL complications. Five patients (7%) had residual fragments larger than 4 mm, necessitating an additional ESWL treatment session. Four patients developed stone streets which were managed by endoscopic meatotomy and Dormia basket extraction of the fragments. All patients with stents (Group II) became stone free within three months with only three patients having persistent post-ESWL renal pain. Using staged ESWL monotherapy it was possible to do gradual debulking of the stone instead of using percutaneous nephrostolithotomy (PCNL) with all its possible hazards. In this series staged ESWL monotherapy for treatment of large and branched calculi proved to be a safe procedure without serious complications. The use of double-pigtail stents added an extra measure of safety to the procedure.
KeywordsExtracorporeal Shock Wave Lithotripsy Ureteral Stents Loin Pain Auxiliary Procedure Extracorporeal Shock Wave Lithotripsy Treatment
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