Porfyris O et al, 2012: Post-extracorporeal shockwave lithotripsy residual stone fragments: clinical significance and management
Porfyris O, Delakas D
Department of Urology, General Hospital of Athens "Asclepieio Voulas", Athens , Greece
Although extracorporeal shockwave lithotripsy (ESWL) is one of the primary treatments for urolithiasis, very often residual fragments of the calculi are still present for a long time after the ESWL session. These fragments are usually asymptomatic and can be managed expectantly, but sometimes they can cause symptoms and require intervention. Secondary procedures are not routinely applied to all patients with residual fragments, but only to those with significant symptoms. Medical therapy may play an important role in the management of residual fragments, by correcting an underlying metabolic disorder and by preventing the growth of residual calculi and the formation of new ones.
Scand J Urol Nephrol. 2012 Jun;46(3):188-95. doi: 10.3109/00365599.2011.644861. Epub 2012 Feb 9
PMID: 22321017 [PubMed - as supplied by publisher]
The literature (or at least most of it) has been reviewed regarding the role and importance of residual fragments after ESWL. The well-recognized wide range of stone-free kidneys and growing as well as stable residuals has been summarized.
Different therapeutic approaches are discussed and the need to remove residuals considered in terms of stone composition and specific individual circumstances. The possibility to use non-invasive procedures for facilitation of fragment clearance is noted and needs consideration. Another factor that is emphasized is the importance to detect metabolic abnormalities and to treat patients with residual fragments according to such findings. The latter aspect is presently a seriously neglected issue for patients with residual fragments (as well as for stone formers in general).