Huang Z et al, 2013: Extracorporeal Shock Wave Lithotripsy for Management of Residual Stones after Ureterolithotripsy versus Mini-Percutaneous Nephrolithotomy: A Retrospective Study
Huang Z, Zhao X, Zhang L, Zhong Z, Xu R, Zhang L
Department of Urology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
PURPOSE: To compare the efficacy of extracorporeal shock wave lithotripsy in managing residual stones after ureterolithotripsy and mini-percutaneous nephrolithotomy.
MATERIALS AND METHODS: A retrospective study was carried out of 71 patients with proximal urinary tract stones (greater than 10 mm) who underwent ureterolithotripsy or mini-percutaneous nephrolithotomy at a single institution from 2009 to 2011. The 71 patients were divided into two groups: group I (n = 37) comprised patients who underwent ureterolithotripsy, and group II (n = 34) comprised patients who underwent mini-percutaneous nephrolithotomy. Clinical characteristics, stone-free rates, stone demographics, and complications were evaluated.
RESULTS: The overall stone-free rate was 90.1%. The stone-free rates in groups I and II were 97.3% and 82.4%, respectively. There was a statistically significant difference in the stone-free rates between groups I and II (P = 0.035). Neither serious intraoperative nor postoperative complications were observed. No significant difference in complications was observed between the two groups (P = 0.472).
CONCLUSIONS: The results of our study suggest that extracorporeal shock wave lithotripsy is an effective and safe auxiliary procedure for managing residual stones after primary endoscopic surgery. This procedure is associated with a satisfactory stone-free rate and a low complication rate, particularly for residual stones after ureteroscopic procedures.
PLoS One. 2013 Jun 13;8(6):e67046. doi: 10.1371/journal.pone.0067046. Print 2013
PMID:23785516[PubMed - in process] PMCID:PMC3681774. FREE ARTICLE
During the study period a satisfying stone-free status was initially achieved in 663 of 752 = 88.2% URL patients and 643 of 745 = 86.3 % mPNL patients. These "patients with residual stones were treated with ESWL as an auxiliary procedure because of a failed consecutive endoscopic procedure or because of a patient's desire for treatment. "
"Thirty-nine (54.9%) patients required only one ESWL session for complete fragmentation of stones, 24 (33.9%) required two sessions, and eight (11.2%) required three sessions. This equates to a total of 111 therapeutic sessions with a mean of 1.56 therapeutic sessions per patient."
The stone free rates after SWL increased in the post URL group from 51.33 % after 2 weeks to 97.3% after 3 months and from 26.5% to 82.4% in the post mPNL group respectively.
The two important informations are: SWL is a non-invasive alternative to reach a high stone free status after unsuccessful endoscopic procedures and - as is well known - the results of SWL should be determined not earlier than 3 months after the treatment.