Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy

Abstract

Purpose: Urinary stone disease is a common medical problem. Extracorporeal shockwave lithotripsy (SWL) has been applied with high success and low complication rates. Steinstrasse (SS) is a possible complication after SWL. The aim of the present study was to prospectively evaluate the factors and outcomes associated with SS after SWL. Materials and Methods:We have prospectively evaluated 265 SWL sessions (2005265 SWL sessions ( -2009. Two lithotriptors were used randomly: Siemens Lithostar and Dornier Compact S. All patients had imaging exams after 30 and 90 days or according to symptoms. Results: SS was observed in 14 (5.3%) out of 265 SWL procedures (n = 175 patients, 51.5% women/48.5% men, mean ± SD age = 46.3 ± 15.5 years). SS was more common after SWL for pelviureteral calculi rather than caliceal stones (p = 0.036). There was a trend toward more occurrences of SS after SWL for larger stone area (> 200 mm 2 , p = 0.072). Preoperative ureteral stent didn't prevent SS. SWL machine, intensity, number of pulses and frequency were not associated with SS formation. Post-SWL pain, fever and gravel elimination were factors associated with SS (p = 0.021; p = 0.011; p = 0.078). When SS occurred, treatment modalities included Medical Expulsive Therapy (MET), ureteroscopy and SWL. Conclusions: Steinstrasse is an uncommon event after SWL and seems to occur more frequently with larger pelviureteral stones. Impaction of stones is more frequent in the middle ureter. All patients should be followed after SWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever. When SS occurs, treatment should be promptly introduced, including medical expulsive therapy, surgical approach or SWL in selected cases. Further prospective studies are awaited to evaluated preventive measures for SS occurrence.

Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial

“…Lodgment of stone fragments inside the ureter may cause ureteral obstruction and severe renal pain requiring urgent intervention. The rate of steinstrasse after renal SWL ranges from 2 to 10%, depending on the initial stone size [27,28]. In the present series, the overall steinstrasse rate was 5.6% with no significant difference being observed between patients on tamsulosin therapy and controls.…”

CUA Guideline: Management of ureteral calculi

“…61 In addition, based on the available evidence, stents do not appear to decrease the risk of steinstrasse or infection following SWL. [62][63][64] However, consideration should still be given to placing a stent prior to SWL in patients with a solitary kidney. 70 Available studies are not sufficiently powered to conclude if a significant difference exists in complication rates such a ureteral perforation, stone migration, or delayed ureteric stricture.…”

Success Factors of Extracorporeal Shock Wave Lithotripsy (ESWL) for Renal & Ureteric Calculi in Adult

“…Steinstrasse is an uncommon event after ESWL and seems to occur more frequently with larger pelvic stones. All patients should be followed after ESWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever [16].…”