Predictive Factors of Lower Calyceal Stone Clearance after Extracorporeal Shockwave Lithotripsy (ESWL): A Focus on the Infundibulopelvic Anatomy

医学 碎石术 体外冲击波碎石术 尿路结石 体外 光学(聚焦) 泌尿科 放射科 外科 解剖 泌尿系统 光学 物理
作者
Islam A. Ghoneim,Ali Ziada,Seif ElDin ElKatib
出处
期刊:European Urology [Elsevier BV]
卷期号:48 (2): 296-302 被引量:61
标识
DOI:10.1016/j.eururo.2005.02.017
摘要

Controversy exists as to whether ESWL is suitable for lower pole renal stones, given the dependant position of the lower calyces. This study aims to test the effect of lower pole anatomy, namely lower polar infundibulo-pelvic angle, infundibular length and width, on clearance of fragments after ESWL. We conducted a retrospective study of 205 renal units with single lower pole stones of not more than 25 mm in their greatest diameter that were treated by ESWL alone. Exclusion criteria included multiple stones, patients requiring stenting or percutaneous drainage for various reasons. Pretreatment IVU was used to measure lower polar dimensions. Post treatment ultrasonography and KUB were used to assess clearance of fragments. The right kidney was involved in 68% and the left in 42% of cases. Average number of sessions was 1.6 with an average 3277 shockwaves per session. 134 patients (65.3%) required one session, 41 requiring 2 sessions (20%), 18 requiring 3 sessions (8.7%), 6 requiring 4 sessions (2.9%) and 8 requiring 5 sessions (3.9%). Complete clearance was attained in 141 cases, while 64 cases had residual fragments, 20 were asymptomatic and required no further management. The lower pole infundibulo-pelvic angle (LIP-A) was the most significant factor in clearance (p value 0.00001). Infundibular length (IL) was also statistically significant (p value 0.039). Lower pole anatomy has a significant impact on ESWL results. LIP-A not less than 70° and an infundibular length of <50 mm is preferable to achieve favorable outcome.
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