Advertisement
No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 2001

LOWER POLE I: A PROSPECTIVE RANDOMIZED TRIAL OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND PERCUTANEOUS NEPHROSTOLITHOTOMY FOR LOWER POLE NEPHROLITHIASIS—INITIAL RESULTS

    View All Author Information

    Purpose:

    The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined.

    Materials and Methods:

    A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less.

    Results:

    Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 mm. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of treated patients. The 3-month postoperative stone-free rates overall were 95% for percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21%) patients becoming stone-free. Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and 2% percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur.

    Conclusions:

    Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.

    References

    • 1 : First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol1982; 125: 417. Google Scholar
    • 2 : Shock wave treatment for stones in the upper urinary tract. Urol Clin North Am1983; 10: 743. Google Scholar
    • 3 : Report of the United States cooperative study of extracorporeal shock wave lithotripsy. J Urol1986; 135: 1127. LinkGoogle Scholar
    • 4 : Consensus Conference. J Urol1989; 141: 804. Google Scholar
    • 5 : Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol1987; 138: 485. LinkGoogle Scholar
    • 6 : Differentiated approach to staghorn calculi using extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy: an analysis of 151 consecutive cases. J Urol1987; 5: 248. Google Scholar
    • 7 : Management of lower pole nephrolithiasis: a critical analysis. J Urol1994; 151: 663. LinkGoogle Scholar
    • 8 : Lithostar extracorporeal shock wave lithotripsy: the first 1,000 patients. J Urol1992; 147: 1006. LinkGoogle Scholar
    • 9 : Experience with a new multifunctional lithotriptor, the Dornier MFL5000: results of 415 treatments. J Endourol1989; 3: 315. Google Scholar
    • 10 : Effectiveness of SWL for lower pole calyceal nephrolithiasis: evaluation of 452 cases. J Endourol1997; 11: 305. Google Scholar
    • 11 : Extracorporeal shock wave lithotripsy for lower pole calculi: long-term radiologic and clinical outcome. J Urol1996; 156: 1572. LinkGoogle Scholar
    • 12 : Extracorporeal shock wave lithotripsy or percutaneous nephrolithotomy for lower pole nephrolithiasis?. J Endourol1996; 10: 17. Google Scholar
    • 13 : Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Urol1998; 159: 676. LinkGoogle Scholar
    • 14 : The role of silicone ureteral stents in extracorporeal shock wave lithotripsy of large renal calculi. J Urol1988; 139: 15. LinkGoogle Scholar
    • 15 : Comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for the treatment of renal calculi in the lower pole calyces. J Endourol1989; 3: 265. Google Scholar
    • 16 : Lithostar: an electromagnetic acoustic shock wave unit for extracorporeal lithotripsy. J Endourol1989; 3: 307. Google Scholar
    • 17 : The etiology and treatment of delayed bleeding following percutaneous lithotripsy. J Urol1985; 133: 447. LinkGoogle Scholar
    • 18 : Complications of percutaneous nephrolithotomy. Am J Roentgenol1987; 148: 177. Google Scholar
    • 19 : Complications and morbidity of endourology. AUA Update Series1985; 4: 2. Google Scholar
    • 20 : Percutaneous stone extraction from 200 patients. J Urol1984; 132: 437. LinkGoogle Scholar
    • 21 : Percutaneous removal of kidney stones: review of 1,000 cases. J Urol1985; 134: 1077. LinkGoogle Scholar
    • 22 : Percutaneous lithopaxy of renal calculi with ultrasound. Eur Urol1982; 8: 236. Google Scholar
    • 24 : ESWL: stone free efficacy based on stone size and location. World J Urol1987; 5: 255. Google Scholar
    • 25 : Extracorporeal lithotripsy and combined surgical procedures in the treatment of renoureteral stone disease: our experience with 2,955 patients. World J Surgery1989; 13: 765. Google Scholar
    • 26 : Role of lithotripsy and its side effects. J Urol1989; 141: 793. AbstractGoogle Scholar
    • 27 : Current advances in shock wave lithotripsy. Curr Opin Urol1999; 9: 319. Google Scholar
    • 28 : Treatment of renal stones by extracorporeal shock wave lithotripsy. Nephron, suppl.1999; 81: 71. Google Scholar
    • 29 : Clearance of lower pole stones following shock wave lithotripsy: effect of the infundibulopelvic angle. Eur Urol1999; 36: 371. Google Scholar
    • 30 : Efficacy and cost-effectiveness of extracorporeal shock wave lithotripsy for solitary lower pole renal calculi. J Urol1998; 159: 24. LinkGoogle Scholar
    • 31 : Extracorporeal shock wave lithotripsy for lower pole nephrolithiasis: efficacy and variables that influence treatment outcome. Urology1998; 51: 544. Google Scholar
    • 32 : Extracorporeal shock wave lithotripsy for lower calyceal calculi. Eur Urol1998; 34: 203. Google Scholar
    • 33 : Single stones of the lower pole of the kidney. Eur Urol1998; 33: 396. Google Scholar
    • 34 : New stone formation: a comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. J Urol1996; 155: 1565. LinkGoogle Scholar
    • 35 : The roles of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy in the management of pyelocaliceal diverticula. J Urol1991; 146: 724. LinkGoogle Scholar
    • 36 : The clinical implications of brushite calculi. J Urol1991; 145: 715. LinkGoogle Scholar
    • 37 : Controlled inversion therapy: an adjunct to the elimination of gravity-dependent fragments following extracorporeal shock wave lithotripsy. J Urol1990; 143: 1096. LinkGoogle Scholar
    • 38 : Adjunct controlled inversion therapy following extracorporeal shock wave lithotripsy for lower pole caliceal stones. J Urol1991; 146: 953. Google Scholar
    • 39 : Mechanical percussion inversion can result in relocation of lower pole stone fragments after shock wave lithotripsy. Urology2000; 55: 204. Google Scholar
    • 40 : Percutaneous caliceal irrigation during extracorporeal shock wave lithotripsy for lower pole renal calculi. J Urol1994; 152: 2227. LinkGoogle Scholar
    • 41 : The use of a cystoscopically placed cobra catheter for directed irrigation of lower pole caliceal stones during extracorporeal shock wave lithotripsy. J Urol1992; 148: 1036. AbstractGoogle Scholar
    • 42 : Extracorporeal shock wave lithotripsy retreatment (“stir-up”) promotes discharge of persistent caliceal stone fragments after primary extracorporeal shock wave lithotripsy. J Urol1992; 148: 1040. AbstractGoogle Scholar
    • 43 : Fate of clinically insignificant residual fragments after extracorporeal shock wave lithotripsy with EDAP LT-01 lithotriptor. J Endourol1993; 7: 453. Google Scholar
    • 44 : Does further extracorporeal lithotripsy promote clearance of small residual fragments?. Br J Urol1991; 68: 565. Google Scholar
    • 45 : Limitations of extracorporeal shock wave lithotripsy for lower calyceal stones: anatomic insight. J Endourol1994; 8: 241. Google Scholar
    • 46 : Comparative follow-up of patients with acute and obtuse infundibulum-pelvic angle submitted to extracorporeal shock wave lithotripsy for lower calyceal stones: preliminary report and proposed study design. J Endourol1997; 11: 157. Google Scholar
    • 47 : Lower pole calyceal stone clearance after shock wave lithotripsy, percutaneous nephrolithotomy, and flexible ureteroscopy: impact of radiographic spatial anatomy. J Endourol1998; 12: 113. Google Scholar
    • 48 : Infundibulopelvic anatomy and clearance of inferior caliceal calculi with shock wave lithotripsy. J Urol2000; 163: 24. LinkGoogle Scholar
    • 49 : Individual patient variation and inter-rater reliability of lower calyceal infundibular width on routine intravenous pyelography. J Urol, suppl.2000; 163: 341. abstract 1511. Google Scholar
    • 50 : Impact of lower pole renal anatomy on stone clearance after shock wave lithotripsy: fact or fiction?. J Urol2001; 165: 1415. LinkGoogle Scholar
    • 51 : Clinical implications of clinically insignificant stone fragments after extracorporeal shock wave lithotripsy. J Urol1996; 155: 1186. LinkGoogle Scholar
    • 52 : The case for primary endoscopic management of upper urinary tract calculi: a critical review of 121 extracorporeal shock wave lithotripsy failures. Urology1995; 45: 363. Google Scholar
    • 53 : Ureteroscopic management of intrarenal calculi. J Urol1998; 159: 1139. LinkGoogle Scholar
    • 54 : Ureteroscopic management of lower pole renal calculi. J Urol1999; 161: 370. Google Scholar
    • 55 : Retrograde ureteropyeloscopic treatment of 2 cm. or greater upper urinary tract and minor Staghorn calculi. J Urol1998; 160: 346. LinkGoogle Scholar
    • 56 : Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol1999; 162: 1904. LinkGoogle Scholar
    • 57 : An acute infundibulopelvic angle predicts failure of flexible ureterorenoscopy for lower calyceal stones. J Urol, suppl.2000; 163: 339. abstract 1505. Google Scholar
    • 58 : Low energy lithotripsy with the Lithostar: treatment results with 19,962 renal and ureteral calculi. J Urol1992; 147: 1419. Google Scholar
    • 59 : Extracorporeal shock wave lithotripsy of urinary calculi: experience in treatment of 3,278 patients using the Siemens Lithostar. J Urol1993; 149: 1419. Google Scholar
    • 60 : Renal calculi in lower pole calices: what is the best method of treatment?. J Urol1991; 146: 721. LinkGoogle Scholar
    • 61 : Intracorporeal electrohydraulic lithotripsy of ureteral and renal calculi using small caliber (1.9Fr) electrohydraulic lithotripsy probes. J Urol1996; 156: 1581. LinkGoogle Scholar
    • 62 : Holmium: YAG laser and its use in the treatment of urolithiasis: our first 160 cases. J Endourol1998; 12: 23. Google Scholar
    • 63 : Principles and applications of laser lithotripsy: experience with the holmium laser lithotrite. J Clin Laser Med Surg1998; 16: 3. Google Scholar
    • 64 : Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones. BJU Int1999; 84: 257. Google Scholar
    • 65 : Management of upper urinary tract calculi with ureteroscopic techniques. Urology1999; 53: 25. Google Scholar
    • 66 : Endoscopic holmium laser lithotripsy for upper urinary tract calculi. J Urol, submitted for publication1999; . Google Scholar
    Advertisement