title: The fate of residual fragments after extracorporeal shock wave lithotripsy monotherapy of infection stones.
abstract: We reviewed 53 patients with infection stones treated by extracorporeal shock wave lithotripsy (ESWL*) monotherapy to determine the long-term rate free of stones and the stone recurrence rate as correlated with the pre-treatment stone burden and the radiological presence of sand or fragments after the procedure. Long-term followup (mean 26.6 months) was available on 33 patients representing 38 kidneys. Although only 3 kidneys were free of stones immediately after ESWL, 20 were without stones at 3 months and 18 (47%) were stone-free at followup. Of 9 kidneys with fragments of more than 5 mm. after the final treatment 7 (78%) had residual fragments at 3 months and experienced stone progression. Of 9 kidneys with sand remaining 6 (66%) and all 3 kidneys that appeared to be free of stones after ESWL were without stones at followup. The 3-month plain film of the kidneys, ureters and bladder was a reliable indicator of eventual outcome. Of 20 kidneys that were free of stones at 3 months 16 remained without stones. Of 18 kidneys with residual stone particles at 3 months 14 showed disease progression, 2 had stable disease and 2 passed residual sand. Only 1 of 17 patients who were free of stones or had stable stone disease had a positive urine culture at followup. Patients with infection stone fragments 3 months after ESWL monotherapy have a high rate of stone progression (78%) and should undergo further treatment. ESWL monotherapy of infection stones requires close patient followup to assure that all residual fragments have passed and urine remains sterile.
authors.affiliation: James Buchanan Brady Foundation, Department of Surgery, New York Hospital, Cornell Medical Center, New York, New York.
authors.forename: E M
authors.initials: EM
authors.lastname: Beck
authors.forename: R A
authors.initials: RA
authors.lastname: Riehle
mesh_terms: D000328:Adult; D000368:Aged; D001031:Apatites; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008096:Lithotripsy; D008274:Magnesium; D017616:Magnesium Compounds; D008297:Male; D008875:Middle Aged; D010710:Phosphates; D011859:Radiography; D012189:Retrospective Studies; D000069877:Struvite; D014552:Urinary Tract Infections / Q000150:complications*
chemical_list: D001031:Apatites; D017616:Magnesium Compounds; D010710:Phosphates; C030782:carboapatite; D000069877:Struvite; D008274:Magnesium