Computed tomography (CT) was performed in 50 patients before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Bilateral treatments were performed in three patients. Post-ESWL scans demonstrated subcapsular hematomas in eight (15%) patients (two large, six small, none symptomatic) and intrarenal hematomas in two (4%) patients. In three (6%) patients small subcapsular fluid collections of uncertain cause were seen. Treated kidneys showed a statistically significant mean increase in size (9%) after ESWL, as measured at the axial level of the major stone fragment. Perinephric soft-tissue stranding and fascial thickening were seen in 37 (70%) of 53 treated renal fossae, with the changes ranging from mild to severe. The authors conclude that while most patients undergoing ESWL will show some posttreatment abnormality on CT scans, the procedure appears to be associated with a low frequency of serious renal trauma.

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Twenty-seven symptomatic, benign postoperative strictures of the ureter or ureteropelvic junction were dilated with balloon or angiographic catheters in an attempt to definitively treat the strictures without surgery. Twenty-three dilatations were performed in antegrade fashion in conjunction with or subsequent to percutaneous nephrostomy, and four strictures were dilated in retrograde fashion per urethra. Thirteen of 27 strictures (48%) were successfully dilated. Certain strictures were more amenable to dilatation than others. In general, the potential for success in dilating ureteral strictures appears to be more dependent on the nature of the stricture than either its duration or the method of dilatation. Based on our initial experience, suggested techniques and guidelines for patient selection are offered.

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