Advertisement

Multistaged Extracorporeal Shock Wave Lithotripsy Monotherapy for Large Renal Calculi

  • Ahmed Mosaad
  • Tarek El-Salamouni

Abstract

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.

Keywords

Extracorporeal Shock Wave Lithotripsy Ureteral Stents Loin Pain Auxiliary Procedure Extracorporeal Shock Wave Lithotripsy Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Payne SR and Webb DR: Percutaneous Renal Surgery. 2nd Edition. New York: Churchill Livingstone, 1988.Google Scholar
  2. 2.
    Lingeman JE: Staghorn calculi: combined percutaneous and ESWL treatment. In Riehle RA and Newman RC (eds): Principles of Extracorporeal Shock Wave Lithotripsy. 1st Edition. New York: Churchill Livingstone, 1987.Google Scholar
  3. 3.
    Eisenberger F, Fuchs G, Miller R, et al: Extracorporeal shock wave lithotripsy (ESWL) and endourology: an ideal combination for the treatment of kidney stones. World J Urol 3: 41, 1985.CrossRefGoogle Scholar
  4. 4.
    Kahnoski RJ, Lingeman JE, Coury TA, et al: Combined percutaneous and extracorporeal shock wave lithotripsy for staghorn calculi: an ideal alternative to anatrophic nephrolithotomy. J Urol 135: 679, 1986.PubMedGoogle Scholar
  5. 5.
    Webb DR, Payne SR, WickhamJEA:Extracorporeal shock wave lithotripsy and percutaneous renal surgery: comparisons, combinations, and conclusions. Br J Urol 58: 1, 1986.PubMedCrossRefGoogle Scholar
  6. 6.
    Winfield H: Staghorn renal calculi: treatment comparison between percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol 135: 181A, 1986.Google Scholar
  7. 7.
    Riehle RA: Selective use of ureteral stents before extracorporeal shock wave lithotripsy. Urol Clin NAm 15: 499, 1988.Google Scholar
  8. 8.
    Brandi H: Treatment of large renal calculi by ESWL. In Riehle RA and Newman RC (eds): Principles of Extracorporeal Shock Wave Lithotripsy. 1st Edition. New York: Churchill Livingstone, 1987.Google Scholar
  9. 9.
    Schulze H, Herde L, Graff J, et al: Combined treatment of branched calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. J Urol 135: 1138, 1986.PubMedGoogle Scholar
  10. 10.
    Shabsigh R, Gleeson MJ, Griffith DP: The benefits of stenting on a more-or-less routine basis prior to extracorporeal shock wave lithotripsy. Urol Clin N Am 15: 493, 1988.Google Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Ahmed Mosaad
    • 1
    • 2
  • Tarek El-Salamouni
    • 1
    • 2
  1. 1.Dr. Soliman Fakeeh HospitalJeddahSaudi Arabia
  2. 2.Department of Urology, Faculty of MedicineAl-Azhar UniversityCairoEgypt

Personalised recommendations