Cicerello E et al, 2012: Management of Clinically Insignificant Residual Fragments following Shock Wave Lithotripsy
Cicerello E, Merlo F, Maccatrozzo L
Unità Complessa di Urologia, Ospedale Regionale Ca'Foncello, Treviso, Italy
Abstract
Clinically insignificant residual fragments (CIRFs) are small fragments (less than 5 mm) that are present in upper urinary tract at the time of regular post-SWL followup. The term is controversial because they may remain silent and asymptomatic or become a risk factor for stone growth and recurrence, leading to symptomatic events, and need further urologic treatment. Although a stone-free state is the desired outcome of surgical treatment of urolithiasis, the authors believe that the presence of noninfected, nonobstructive, asymptomatic residual fragments can be managed metabolically in order to prevent stone growth and recurrence. Further urologic intervention is warranted if clinical indications for stone removal are present.
Adv Urol. 2012;2012:320104. doi: 10.1155/2012/320104. Epub 2012 May 31
PMID: 22701479 [PubMed - in process]. FREE ARTICLE
Comments 1
52 references accompany this review which collects what is known about the topic. It would have been more informative for the reader if the authors would have offered analysis of conflicting data like why the regrowth rates in the literature vary between 2, 1% and 59%. In the current EAU guideline on urolithiasis the recommendations for the treatment of residual fragments are accompanied by the lowest levels of evidence (LE: 4) and grade of recommendation (GR: C). There is still work do be done.
Peter Alken