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Mustafa M, 2011: Is the gravity effect of radiographic anatomic features enough to justify stone clearance or fragments retention following extracorporeal shock wave lithotripsy (SWL)

Mustafa M
Urology Department, Osmaniye State Hospital, Osmaniye, Turkey


Abstract

We determined whether the gravity effect of radiographic anatomic features on the preoperative urography (IVP) are enough to predict fragments clearance after shock wave lithotripsy (SWL). A Total of 282 patients with mean age 45.8 ± 13.2 years (189 male, 93 female), who underwent SWL due to renal calculi between October 2005 and August 2009 were enrolled. The mean calculi load was 155.72 ± 127.66 mm². The patients were stratified into three groups: patients with pelvis calculi (group 1); patients with upper or middle pole calculi (group 2) and patients with lower pole calculi (group 3). Three angles on the pretreatment IVP were measured: the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle I); the inner angle between the lower pole infundibular axis and main axis of pelvis-ureteropelvic (UP) junction point (angle II) and the inner angle between the lower pole infundibular axis and perpendicular line (angle III). Multivariate analysis was used to define the significant predictors of stone clearance. The overall success rate was 85.81%. All angles, sessions number, shock waves number and stone burden were significant predictors of success in patients in group 1. However, in group 2 only angle II and in group 3 angles I and II had significant effect on stone clearance. Radiographic anatomic features have significant role in determining the stone-free rate following satisfactory fragmentation of renal stones with SWL. The measurement of infundibulopelvic angle in different manner helps to predict the stone-free status in patients with renal calculi located not only in lower pole, but also in renal pelvis and upper or middle pole. Gravity effect is not enough to justify the significant influence of the radiographic anatomic features on the stone clearance and fragments retention after SWL.

Urol Res. 2012 Aug;40(4):339-44. doi: 10.1007/s00240-011-0412-8. Epub 2011 Aug 17
PMID: 21847556 [PubMed - as supplied by publisher]

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Comments 1

Hans-Göran Tiselius on Friday, 12 August 2011 15:01

This is another report describing the possibility to predict stone clearance from various geometrical measurements of the intrarenal anatomy. Cut-off values are given for the three different angels discussed in the article. The differences are obviously small and it is likely that other factors such as for instance contractility of the calyces also play an important role for stone clearance.

The authors recommend using the best predictive angle, that between the axis of the lower calyx infundibulum and the main axis of the renal pelvis –ureteroplevic junction axis, as a predictive factor for successful ESWL. It is difficult to know the clinical usefulness of such a complicated geometrical analysis before proceeding to stone removal. It is, moreover, of note that with the very common use of NCCT examinations in the diagnostic work up of patients with urolithiasis accurate geometrical measurements are not easily accomplished.

Hans-Göran Tiselius

This is another report describing the possibility to predict stone clearance from various geometrical measurements of the intrarenal anatomy. Cut-off values are given for the three different angels discussed in the article. The differences are obviously small and it is likely that other factors such as for instance contractility of the calyces also play an important role for stone clearance. The authors recommend using the best predictive angle, that between the axis of the lower calyx infundibulum and the main axis of the renal pelvis –ureteroplevic junction axis, as a predictive factor for successful ESWL. It is difficult to know the clinical usefulness of such a complicated geometrical analysis before proceeding to stone removal. It is, moreover, of note that with the very common use of NCCT examinations in the diagnostic work up of patients with urolithiasis accurate geometrical measurements are not easily accomplished. Hans-Göran Tiselius
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