Ullah A et al, 2015: FREQUENCY AND FACTORS EFFECTING NON CLEARANCE OF LOWER POLE RENAL STONES.
Ullah A, Zubair M, Khan N, Malik A.
BACKGROUND: Renal stone disease is a major health hazard in Pakistan and extra-corporeal shockwave lithofripsy is one of comprehensive method used to treat these stones. The aim of this study is to determine the frequency of factors affecting the non-clearance of stone fragments of lower pole renalstone after extra corporeal shockwave lithotripsy. The study was done with the objective to determine the frequency the spatial anatomical factors which can influence the non-clearance of lower pole stone fragments after ESWL.
METHODS: One and nineteen (119) patients with lower pole renal stone less than 10 mm were subjected to maximum 3 sessions of extracorporeal shock wave lithotripsy. KUB radiographs, ultrasonography and intravenous urography were used as investigative tools for lower pole renal calyceal anatomy. X ray KUB and ultrasound were done after a week for clearance. Data was analysed with the help of SPSS version 10.0 and presented in the forms of tables and graphs.
RESULTS: There were 77 (64.71%) males and 42 (35.29%) females. Infundibulo-pelvic angle (IPA)>40' was present in 93 (78.15%), Infundibular length (IL) <22 mm in 107 (89.92%) and Infundibular width (W) >4 mm was present in 100 (84.03%) patients. The frequency of stone non clearance was noted in 31 (26.05%). Infundibulo-pelvic angle (IPA)>40 degrees (p=0.000), Infundibular length (IL)<22 mm (p=0.001) and Infundibular width (IW)>4 mm (p=0.046) were significant variables affecting stone clearance.
CONCLUSION: The frequency of non-clearance of lower calyx of kidney stone is 26.05%. The clearance of fragments of the lower calyx kidney stones is affected by. three spatial anatomical factors, i.e., Infundibulopelvic angle, Infundibular width and infundibular length.
J Ayub Med Coll Abbottabad. 2015 Apr-Jun;27(2):384-7.
The role of the geometrical anatomy of the lower calyx system remains a matter of debate. In this report comprising 119 patients treated with a maximum of three SWL sessions for ≤10 mm large stones in the lower calyx, the stone-free rate was 74%.
In the 26% with treatment failures the following geometrical observations were made:
Like in most other reports of this kind, the measurements were obtained from IVP examinations. This imaging procedure is not so common today and my own impression is that corresponding measurements on NCCT examinations are difficult.