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Extracorporeal shock wave lithotripsy monotherapy for selected staghorn stones.
Singapore Med J. 1995 Feb; 36(1):53-5.SM

Abstract

OBJECTIVE

To define a subgroup of staghorn stones that is amenable to extracorporeal shockwave lithotripsy (ESWL) monotherapy and review the need for prophylactic ureteric stents.

METHODS

Fifty-eight renal units with staghorn calculi in 56 patients (30 males and 26 females) were treated by ESWL monotherapy on the EDAP LT-01 lithotripter. The stones were grouped as complete staghorn (11, 19%), partial staghorn (34, 59%) and borderline staghorn (13, 22%). Results of treatment were analysed in relation to subgroup and calyceal dilatation. Post-treatment complications were studied and the influence of prophylactic ureteric stents examined.

RESULTS

The average number of ESWL sessions was 3.1 (range: 1 to 8). The mean follow-up period was 13 months. Stone-free rate at 10 months was 52%. When clinically insignificant residual fragments less than 4mm were included, the overall clearance rate was 75%. Favourable factors influencing treatment outcome included smaller stone burden, peripheral distribution of stone mass and absence of pelvicalyceal dilatation. The overall complication rate was 39% with urosepsis being the commonest. Complications were related to stone burden. More than half of the renal units with complete staghorn stones developed one or more complications. Auxiliary procedures were required in 18% of the renal units. Twenty of 39 renal units with a stone burden (sum of length and width) greater than 50mm had pretreatment ureteric stenting using the double-J (DJ) siliastic stent. A urosepsis rate of 50% was noted in those with ureteric stents compared to 26% in those not stented. The stents did not offer any advantage in preventing post-treatment obstruction by fragments. Six of 7 renal units with post-treatment obstruction had in-situ stents.

CONCLUSIONS

ESWL monotherapy is suitable for selected staghorn stones. Prophylactic ureteric stents do not offer any advantage and may predispose to urosepsis.

Authors+Show Affiliations

Tan PK
Department of Surgery, Tan Tock Seng Hospital, Singapore.
Tan EC
No affiliation info available
Tung KH
No affiliation info available
Foo KT
No affiliation info available

MeSH

AdultAgedFemaleHumansKidney CalculiLithotripsyMaleMiddle AgedStentsTreatment OutcomeUrinalysis

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7570136

Citation

Tan, P K., et al. "Extracorporeal Shock Wave Lithotripsy Monotherapy for Selected Staghorn Stones." Singapore Medical Journal, vol. 36, no. 1, 1995, pp. 53-5.
Tan PK, Tan EC, Tung KH, et al. Extracorporeal shock wave lithotripsy monotherapy for selected staghorn stones. Singapore Med J. 1995;36(1):53-5.
Tan, P. K., Tan, E. C., Tung, K. H., & Foo, K. T. (1995). Extracorporeal shock wave lithotripsy monotherapy for selected staghorn stones. Singapore Medical Journal, 36(1), 53-5.
Tan PK, et al. Extracorporeal Shock Wave Lithotripsy Monotherapy for Selected Staghorn Stones. Singapore Med J. 1995;36(1):53-5. PubMed PMID: 7570136.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracorporeal shock wave lithotripsy monotherapy for selected staghorn stones. AU - Tan,P K, AU - Tan,E C, AU - Tung,K H, AU - Foo,K T, PY - 1995/2/1/pubmed PY - 1995/2/1/medline PY - 1995/2/1/entrez SP - 53 EP - 5 JF - Singapore medical journal JO - Singapore Med J VL - 36 IS - 1 N2 - OBJECTIVE: To define a subgroup of staghorn stones that is amenable to extracorporeal shockwave lithotripsy (ESWL) monotherapy and review the need for prophylactic ureteric stents. METHODS: Fifty-eight renal units with staghorn calculi in 56 patients (30 males and 26 females) were treated by ESWL monotherapy on the EDAP LT-01 lithotripter. The stones were grouped as complete staghorn (11, 19%), partial staghorn (34, 59%) and borderline staghorn (13, 22%). Results of treatment were analysed in relation to subgroup and calyceal dilatation. Post-treatment complications were studied and the influence of prophylactic ureteric stents examined. RESULTS: The average number of ESWL sessions was 3.1 (range: 1 to 8). The mean follow-up period was 13 months. Stone-free rate at 10 months was 52%. When clinically insignificant residual fragments less than 4mm were included, the overall clearance rate was 75%. Favourable factors influencing treatment outcome included smaller stone burden, peripheral distribution of stone mass and absence of pelvicalyceal dilatation. The overall complication rate was 39% with urosepsis being the commonest. Complications were related to stone burden. More than half of the renal units with complete staghorn stones developed one or more complications. Auxiliary procedures were required in 18% of the renal units. Twenty of 39 renal units with a stone burden (sum of length and width) greater than 50mm had pretreatment ureteric stenting using the double-J (DJ) siliastic stent. A urosepsis rate of 50% was noted in those with ureteric stents compared to 26% in those not stented. The stents did not offer any advantage in preventing post-treatment obstruction by fragments. Six of 7 renal units with post-treatment obstruction had in-situ stents. CONCLUSIONS: ESWL monotherapy is suitable for selected staghorn stones. Prophylactic ureteric stents do not offer any advantage and may predispose to urosepsis. SN - 0037-5675 UR - https://www.unboundmedicine.com/medline/citation/7570136/Extracorporeal_shock_wave_lithotripsy_monotherapy_for_selected_staghorn_stones_ DB - PRIME DP - Unbound Medicine ER -