Acar C et al, 2012: Impact of Residual Fragments following Endourological Treatments in Renal Stones
Acar C, Cal C
Department of Urology, Faculty of Medicine, Pamukkale University, 20070 Denizli, Turkey
Today, shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and flexible ureterorenoscopy (URS) are the most widely used modalities for the management of renal stones. In earlier series, treatment success of renal calculi assessed with KUB radiography, ultrasound, or intravenous pyelography which are less sensitive than CT that leads to be diversity of study results in reporting outcome. Residual fragments (RFs) after interventional therapies may cause pain, infection, or obstruction. The size and location of RFs following SWL and PCNL are the major predictors for clinical significant symptoms and stone events requiring intervention. There is no consensus regarding schedule for followup of SWL, PCNL, and flexible URS. Active monitoring can be recommended when the stones become symptomatic, increase in size, or need intervention. RFs
Adv Urol. 2012;2012:813523. doi: 10.1155/2012/813523. Epub 2012 Jul 5
The authors have made a review of some reports in the literature dealing with the problem of residual fragments after ESWL and endo-urological procedures. The bottom-line is that the course of residual fragments is unpredictable and that a conservative attitude can be applied, because a significant part of the fragments will either pass or remain stable. This recommendation can be followed as long as the fragments are asymptomatic and of non-infection type. When additional procedures appear necessary a low-invasive technique is recommended such as ESWL or RIRS/URS. I fully support the authors in this regards.
The article also contains a review on the experience with medical treatment of patients with residual fragments and it is concluded that such an approach is less expensive than interventions.
The costs reported for active removal of residuals (based on economic analysis of removal of stones ≤20 mm) were as follows:
On the other hand the cost of medical intervention varied between USD 29 and 508 per year.