title: Extracorporeal shock wave lithotripsy as first line monotherapy of solitary calyceal calculi.
abstract: Eighty-four patients with solitary calyceal stones were treated with Extracorporeal Shock Wave Lithotripsy (ESWL) as first line monotherapy. The indications for treatment were pain in 51 patients (61%), infection in 11 patients (13%), pain and infection in 18 patients (21%) and others in 4 patients (5%). Stone size (largest diameter) was median 9 mm (range 2-25 mm). Follow-up consisted of clinical control, isotope renography and a plain film after 1 month; hereafter plain films after 3 and 6 months. Auxiliary procedures due to steinstrasse were performed in 3 out of 4 patients (1 nephrostomy, 1 nephrostomy + ESWL of ureteral fragments, and 1 ureteroscopic manipulation). Retreatment of the calyceal stone was performed in 3 patients within 6 months (2 re-ESWL, 1 lower pole resection). Stone-free (without retreatment or auxiliary procedures) were 26/84 (31%) after 1 month, 34/84 (40%) after 3 months and 38/84 (45%) after 6 months. Free of pain were 43/69 (62%) after 1 month, 50/69 (72%) after 3 months and 59/69 (86%) after 6 months. Free of infection were 18/29 (62%) after 1 month, 19/29 (66%) after 3 months and 21/29 (72%) after 6 months. Complications included steinstrasse in 4 patients, sepsis in 3 patients, displacement of JJ-stent in 2 patients and atrio-ventricular dissociation in 1 patient. To conclude: ESWL as first line therapy for solitary calyceal calculi offers good results with regard to pain and clearance of infection, but leaves 55% with residual stone material.
authors.affiliation: Copenhagen Municipal Stone Center, Department of Urology Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: K H
authors.initials: KH
authors.lastname: Andreassen
authors.forename: C
authors.initials: C
authors.lastname: Dahl
authors.forename: J T
authors.initials: JT
authors.lastname: Andersen
authors.forename: M S
authors.initials: MS
authors.lastname: Rasmussen
authors.forename: J D
authors.initials: JD
authors.lastname: Jacobsen
authors.forename: P
authors.initials: P
authors.lastname: Mogensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D007670:Kidney Calices / Q000000981:diagnostic imaging; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011859:Radiography; D012008:Recurrence; D019233:Retreatment; D016896:Treatment Outcome