Cui H et al, 2013: Efficacy of the lithotripsy in treating lower pole renal stones
Cui H, Thomee E, Noble JG, Reynard JM, Turney BW.
The Oxford Stone Group, The Churchill Hospital, Oxford, OX3 7LF, UK
Use of extracorporeal lithotripsy is declining in North America and many European countries despite international guidelines advocating it as a first-line therapy. Traditionally, lithotripsy is thought to have poor efficacy at treating lower pole renal stones. We evaluated the success rates of lithotripsy for lower pole renal stones in our unit. 50 patients with lower pole kidney stonesB15 mm treated between 3/5/11 and 19/4/12 were included in the study. Patients received lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter according to a standard protocol. Clinical success was defined as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) B3 mm at radiological follow-up. The mean stone size was 7.8 mm. The majority of stones (66 %) were between 5 and 10 mm. 28 % of stones were between 10 and 15 mm. For solitary lower pole stones complete stone clearance was achieved in 63 %. Total stone clearance including those with CIRFs was achieved in 81 % of patients. As expected, for those with multiple lower pole stones the success rates were lower: complete clearance was observed in 39 %and combined clearance including those with CIRFs was 56 %. Overall, complete stone clearance was observed in 54 % of patients and clearance with CIRFs was achieved in 72 % of patients. Success rate could not be attributed to age, stone size or gender. Our outcome data for the treatment of lower pole renal stones (B15 mm) compare favourably with the literature. With this level of stone clearance, a non-invasive, outpatient based treatment like lithotripsy should remain the first-line treatment option for lower pole stones. Ureteroscopy must prove that it is significantly better either in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.
Urolithiasis. 2013 Mar 3. [Epub ahead of print]
PMID:23456210 [PubMed - as supplied by publisher]
This is a classical paper in many ways: "Lithotripsy was ... gradually increased to the highest tolerable/ maximum recommended intensity at a frequency of 1.5–2 Hz for a maximum of 4,000 shocks. We aimed to deliver 4,000 shocks in each treatment in total but reduced this if the patient could not tolerate the treatment or if the stone was adequately fragmented. ... Most stones required two or three lithotripsy sessions"
The complete stone clearance rate of 54 % /72% without /with CIRF or 81% for solitary stones is definitively better than "The widely cited lower pole stone papers of Albala et al.  and Pearle et al.  demonstrated a low success rate (35–37 %) with lithotripsy."
But modern times sing a different song: