Efficacy of the lithotripsy in treating lower pole renal stones

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.

Comparison of Extracorporeal Shock Wave Lithotripsy versus Ureteroscopy Holmium Laser Lithotripsy in the Management of Ureteral Stones: A Cost-effectiveness Analysis

“…On the other hand, the higher cost of lithotripsy was linked it to the cost of purchasing and maintenance of the lithotripter. Cui et al [20] found a high effectiveness with both treatments, but the cost was significantly lower for the ESWL without differences in the rate of severe complications. The recovery time was significantly lower in the ESWL group compared with the URSL group, and the lower urinary tract symptoms rates were higher for the group of the URSL.…”

Lower Pole Calyceal Stone and Lithotripsy are Issues with Clearance Fact or Reality?

“…SWL is the mainstay for the treatment of the majority of small and moderate-sized renal stones in all calyces except LPC. 8 The treatment outcome following SWL depends on the type of lithotripter, patient characteristics like body mass index (BMI), skin to stone distance, stone composition, stone size and intra calyceal distribution. However, one of the most significant factor-affecting outcomes is the stone's characteristics (i.e., number, size, composition and location), renal anatomy, and function.…”

Role of kidney stones in renal pelvis flow

“…Prior to laser-induced fragmentation, kidney stone sizes range between 5 and 10 mm (66%), and 10 and 15 mm (28%) (Cui et al, 2013). After ablation, the stone is reduced to a large number of fragments, ranging in radii from 𝑅 𝑠 = 1 𝜇m to 𝑅 𝑠 = 10 mm.…”