Stones in anomalous kidneys: Results of treatment by shock wave lithotripsy in 150 patients

Abstract

Objective : To determine the efficacy of shock wave lithotripsy (SWL) in anomalous kidneys. Methods : From October 1990 to October 2002, 150 patients (93 men and 57 women) with anomalous urinary tracts, including 45 horseshoe kidneys, 57 duplex kidneys, 30 malrotated kidneys, 14 pelvic and four crossed ectopic kidneys were treated with SWL for urolithiasis at the Gazi University Faculty of Medicine. Shock wave lithotripsy was performed with Siemens Lithostar plus (Siemans, Erlanger, Germany) device and all procedures were carried under fluoroscopic control.Results : The mean shock wave number and intensity received by the patients was 3770 (range, 1380-4100) shocks and 18.4 (range, 16.1-19) kV per session, respectively. The minimum success rate was obtained in patients with lower calyceal (50%) followed by middle calyceal (60%) calculi. The stonefree rate decreased and the number of sessions per patient increased with increasing stone diameter (dm). In patients with a stone dm > 30 mm, only 34% could be stone-free, compared to a rate of 92% for calculi dm < 10 mm. The overall stone free rate at the third month was 68%. The best stonefree rates were obtained in patients with ureteral duplication (80.7%). The stone-free rates in horseshoe, malrotated, pelvic and crossed ectopic kidneys were found to be 66.7%, 56.7%, 57.2% and 25%, respectively. Conclusion : Shock wave lithotripsy might be an effective and minimally invasive treatment alternative in stone-bearing anomalous kidneys. The type of anomaly, stone burden and localization seem to be the main parameters effecting the treatment success.

Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters

“…This is because the shock wave fired loses energy as it travels through excess body fat in a patient with an elevated body mass index [29] . Pelvic kidneys and horseshoe kidneys also have a lower stone-free rate with a greater number of SWL sessions needed to achieve success [30,31] . SWL is generally not recommended in patients with a calculus in a calyceal diverticulum.…”

Retrograde intrarenal surgery for renal stones - Part 2

“…Clearance of fragments after SWL can be unsuccessful in kidneys with isolated renal rotation anomaly because of the obstruction. Tunc et al [39] evaluated SWL in 150 kidneys with anomalies, where SFR was found to be 56.7% that was lower than in normal kidneys.…”

Flexible ureterorenoscopy in position or fusion anomaly: Is it feasible?

“…Sheir et al 23 reported a general success rate of ESWL in anomalous kidneys of 72.2%, with only 46.1% for stones > 15 mm. 1 Tunc et al, 24 in turn, reported a rate of 92% for stones < 10 mm, but 34% for those greater than 30 mm. 3 Coupled with lower efficiency of ESWL in eliminating larger stones, Ray et al 13 has pointed out that 51% of their patients needed an additional procedure, but that little improvement occurred after the second session, revealing a limitation in the number of attempts that could be made.…”