Single Stones of the Lower Pole of the Kidney

Havel, Denis; Saussine, C.; Fath, Christian; Lang, Hervé; Fauré, François; Jacqmin, Didier

doi:10.1159/000019623

Cited by 52 publications

(11 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another option for minimally invasive treatment of lower calyceal stones is percutaneous lithotripsy. Although it is associated with a higher stone–free rate (85%), because of its higher morbidity most urologists reserve this procedure for lower–pole calculi larger than 2 cm [93]. However, this cutoff point has been recently contested.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Renal Stones by Extracorporeal Shockwave Lithotripsy

et al. 2001

View full text Add to dashboard Cite

Aim: Despite the extensive experience with minimal invasive stone therapy, there are still different views on the ideal management of renal stones. Materials and Methods: Analysis of the literature includes more than 14,000 patients. We have compared these data with long–term results of two major stone centers in Germany. The results have been compared concerning the anatomical kidney situation, stone size, stone localization and observation time. Results: According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinically insignificant residual fragments and clinically significant residual fragments (CIRF). 24 months following ESWL stone passage occurs as a continous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as overtreatment. According to these results, stone–free rates of patients increase in longer follow–up periods. Newer ESWL technology has increased the percentage of CIRF. Conclusion: We consider ESWL in most patients with renal calculi as first–line treatment, except in patients with renal calculi bigger than 30 mm in diameter.

show abstract

Section: Resultsmentioning

confidence: 99%

Treatment of Renal Stones by Extracorporeal Shockwave Lithotripsy

et al. 2001

View full text Add to dashboard Cite

show abstract

“…4 To treat lower pole calyceal stones less than 1 cm, some studies demonstrated that SWL is equally effective as PNL. 2 Furthermore, Pearle and colleauges reported that the outcomes of SWL are comparable to those of ureteroscopic stone removal for treating lower pole calculi 1 cm or less considering more patient acceptance and short recovery periods. 1,13 However, excellent surgical outcomes have been reported for PNL in treating lower pole calyceal stones 1 cm or larger.…”

Section: Discussionmentioning

confidence: 99%

“…Havel and colleagues demonstrated that PNL has better outcomes than SWL for solitary, lower pole calculus. 2 May and colleagues reported that PNL is better than SWL for treating lower pole calyceal stones over 2 cm. 3 Since then, Albala and colleagues reported the results of a comparison between SWL and PNL for treating lower pole calyceal stones.…”

Section: Introductionmentioning

confidence: 99%

The feasibility of shockwave lithotripsy for treating solitary, lower calyceal stones over 1 cm in size

Kim

Lee

Kim

et al. 2013

CUAJ

View full text Add to dashboard Cite

Introduction:Recently, few studies were reported about the treatment of large, solitary, renal calculi between shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL). We assess the feasibility of SWL for managing solitary, lower calyceal stones over 1 cm by comparing the results of lower pole calculi treatment between patients that underwent SWL or PNL. Methods: We retrospectively reviewed clinical data for patients who had undergone PNL or SWL due to lower calyceal stones over 1 cm. Group 1 consisted of patients who underwent SWL to treat lower pole renal calculi from 2010 to 2011. Group 2 included patients who underwent PNL to manage lower pole renal calculi from 2008 to 2009. We compared patient age, gender, stone size, comorbidities, postoperative complications, additional interventions and anatomical parameters between the two groups. Results: A total of 55 patients were enrolled in this study. The mean ages (±SD) of groups 1 (n = 33) and 2 (n = 22) were 55.1 (±13.0) and 50.0 (±10.6) years (p = 0.133) and mean stone sizes were 1.6 (±0.7) and 1.9 (±0.8) cm (p = 0.135), respectively. There were no significant differences in gender distribution, comorbidities or stone laterality between the two groups. No significant differences in various parameters were observed between patients with stones 1 to 2 cm and ones with stones 2 cm or larger. Conclusions: Our results demonstrated that SWL is a safe, feasible treatment for solitary, lower calyceal stones over 1 cm. IntroductionExtracorporeal shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL) have been performed since the early 1980s to surgically treat patients with renal stones. Recently, retrograde ureteroscopic stone removal using a laser device was introduced following the technical development of devices.1 However, the management of larger renal calculi over 1 cm remains problematic and can be further complicated by the location of the stone, particularly ones in the lower pole calyx. Havel and colleagues demonstrated that PNL has better outcomes than SWL for solitary, lower pole calculus.2 May and colleagues reported that PNL is better than SWL for treating lower pole calyceal stones over 2 cm.3 Since then, Albala and colleagues reported the results of a comparison between SWL and PNL for treating lower pole calyceal stones. 4 They suggested poor stone-free clearance of SWL and introduced a technique for measuring various parameters related to lower calyx anatomy, such as lower pole infundibular length and width along with the lower pole infundibulopelvic angle. This group also suggested predictive values of these anatomical parameters for stone-free clearance. Chibber and colleagues emphasized the predominant effectiveness of PNL for managing lower pole calyceal stones 1 to 2 cm. 5Despite these findings, the use of PNL may be limited for the general population as this procedure involves invasive renal parenchymal puncture to access the renal calyceal stones, and should be performed under general anesthesia with the patie...

show abstract

“…[8] In addition, the need for blood transfusion can rise from 6% up to 20% when opening the percutaneous tract with wider calibrations and with intrarenal manipulations during PCNL. [9,10] The factors associated with bleeding include: multiple entries, supracostal entry, dilatation of the tract, tract dilatation with different procedures other than with balloon dilatation, prolonged operation time and renal pelvis perforation. [8] However, most bleeds are from the renal parenchyma, which are not imperative in many cases.…”

Section: Discussionmentioning

confidence: 99%

Effects of Previous Unsuccessful Extracorporeal Shockwave Lithotripsy Treatment on the Performance and Outcome of Percutaneous Nephrolithotomy

Garg¹,

Mishra²,

Bharti³

et al. 2017

jemds

View full text Add to dashboard Cite

BACKGROUNDMajority of renal stones diagnosed today are below 2 cm, perhaps due to easy and early accessibility to x-ray and ultrasonography. The preferred treatment of < 1 cm stone is extracorporeal shockwave lithotripsy (ESWL), while standard of care for renal stone > 2 cm is percutaneous nephrolithotomy (PCNL). The procedure of choice for 1 -2 cm renal stones is still a subject of debate. Controversy exists with regard to optimum management of these stones by percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) with reference to stone clearance, hospital stay and complications. The primary goal while treating renal stones is to achieve complete clearance, while causing minimal morbidity to the patient. Treatment of renal stone depends on stone size and location plus patient related factors including anatomy of pelvicalyceal system. In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications and LOS in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.The objective of this study is to evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODSOf 115 PCNL procedures performed in our institute with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised of 42 (36.5%) ESWL-treated patients and Group 2 comprised of 73 (63.4%) non-ESWLtreated patients. RESULTSThere were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declined and more transfusions were required in the ESWL-treated patients (both P= 0.01). CONCLUSIONMany patients who undergo PCNL have undergone ESWL treatment beforehand. The renal side-effects of ESWL are well known, the duration of which varies between studies. In the present study, we found that previous ESWL had an effect on bleeding during the PCNL procedure.

show abstract

Single Stones of the Lower Pole of the Kidney

Cited by 52 publications

References 25 publications

Treatment of Renal Stones by Extracorporeal Shockwave Lithotripsy

Treatment of Renal Stones by Extracorporeal Shockwave Lithotripsy

The feasibility of shockwave lithotripsy for treating solitary, lower calyceal stones over 1 cm in size

Effects of Previous Unsuccessful Extracorporeal Shockwave Lithotripsy Treatment on the Performance and Outcome of Percutaneous Nephrolithotomy

Contact Info

Product

Resources

About