Extracorporeal Shock-Wave Lithotripsy in Renal and Ureteric Calculi: Role in Resource Poor Developing Countries in Modern Era

Abstract

Introduction: Extracorporeal shock-wave lithotripsy (ESWL) is an established non-invasive treatment modality for renal and ureteric stones. However, treatment outcome and efficacy depends on multiple factors like stone size, location and type of machine used. We aimed to assess efficacy of ESWL as a primary treatment modality in renal and ureteric stones in a busy hospital setting having significant renal stone disease burden. Material and methods:1187 patients who underwent ESWL between January 2015 to December 2016 in our department were included in the study. Patients with nephrolithiasis and ureterolithiasis having functional kidney, without any absolute contraindication to ESWL were included. Dornier Med Tech Compact Delta 2 machines were used for all the patients. Stone localization was done using both fluoroscopic and ultrasound-guided methods by same expert. Results: Out of 1187 patients,887 patients had solitary renal stones,170 had solitary ureteral calculus and 130 patients had multiple renal calculi. Stone size ranged from 8mm-20mm. Renal pelvic stones, upper calycial stones and proximal ureteric stones had stone free rate of 84%,86% and 82.5% respectively. 89% and 84% of patients were stone free when size of stone was between 8-12mm, it decreased to 77% and 73% when size increased between 13-16mm for kidney and ureteric stones respectively. Conclusions: ESWL is an effective primary treatment modality for appropriately selected patients with stone size less than 2 cm in favorable location with a normal functioning kidney. Use of both fluoroscopic and ultrasound imaging improves localization of stones thus improving success. It is an important modality in hands of urologist treating huge volume of urolithiasis patients in busy hospitals with long waiting list and with limited resources.