Indian Journal of Urology (Jan 2010)

Outcome of shock wave lithotripsy as monotherapy for large solitary renal stones (>2 cm in size) without stenting

  • Shanmugasundaram Rajaian,
  • Santosh Kumar,
  • Ganesh Gopalakrishnan,
  • Ninan K Chacko,
  • Antony Devasia,
  • Nitin S Kekre

DOI
https://doi.org/10.4103/0970-1591.70568
Journal volume & issue
Vol. 26, no. 3
pp. 359 – 363

Abstract

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Purpose : To evaluate the outcome of shock wave lithotripsy (SWL) as monotherapy for solitary renal stones larger than 2 cm without ureteral stenting. Materials and Methods : Our retrospective study included patients with solitary renal radio opaque stones larger than 2 cm treated with SWL using electromagnetic Dornier Compact S lithotripter device (Wessling, Germany) for a period of 3 years (September 2002-2005). Stone clearance was assessed at 1 week, 1 month, and 3 months with plain X-rays of kidney, ureter, and bladder region, ultrasonography, and tomograms. Stone-free status, morbidity of the procedure, and fate of clinically insignificant residual fragments (CIRF) were studied. A stone-free state was defined as no radiologic evidence of stone. Success was defined as complete clearance + CIRF. Results : Fifty-five patients, aged 11-65 years (mean 49.8) underwent SWL. Of them, only two were children. Male-to-female ratio was 3:1. The stone size was 21-28 mm (average 24 mm). The mean number of shocks were 3732 (range 724-12,100) and average energy level was 14 kV (range 11-16 kV). The mean follow-up was 18 months (range 3-22 months). Over all, stone-free status was achieved in 50% and success in 81% at 3 months. Stone clearance was not affected by stone location. Stones 26 mm) (P = -0.10). Of 54 patients, 39 developed steinstrasse with mean length of 3.2 cm (range 1.4-6.2 cm) and only four required intervention. Effectiveness quotient (EQ) for SWL monotherapy for solitary renal stones more than 2 cm was 25.3%. The EQ for stones <25 mm and those more than 25 mm were 28.4% and 10% (P = -0.12), respectively. There was a lesser trend of difference between stones with size <25 and more than 25 mm. During the last review, the overall stone-free rate was 67.2%. Conclusions : SWL monotherapy was safe but significantly less effective for solitary renal stones larger than 2 cm. It can only be suggested to those who refuse surgical intervention. Pretreatment DJ stenting is not mandatory when closer follow-up is ensured.

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