title: Lower-pole caliceal stone clearance after shockwave lithotripsy, percutaneous nephrolithotomy, and flexible ureteroscopy: impact of radiographic spatial anatomy.
abstract: Spatial anatomy of the lower renal pole, as defined by the infundibulopelvic angle (LIP angle), infundibular length (IL), and infundibular width (IW), plays a significant role in the stone-free rate after shockwave lithotripsy. A wide LIP angle, a short IL, and a broad IW, individually or in combination, favor stone clearance, whereas a LIP <70 degrees, an IL >3 cm, or an IW < or =5 mm are individually unfavorable. When all three unfavorable factors or an unfavorable LIP and IL coexist, the post-SWL stone-free rate falls to 50% or less. Using these criteria, more than one fourth of our patients with a lower-pole calculus might have been better served by an initial percutaneous or perhaps ureteroscopic procedure, neither of which is significantly affected by the lower-pole spatial anatomy.
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Elbahnasy
authors.forename: R V
authors.initials: RV
authors.lastname: Clayman
authors.forename: A L
authors.initials: AL
authors.lastname: Shalhav
authors.forename: D M
authors.initials: DM
authors.lastname: Hoenig
authors.forename: P
authors.initials: P
authors.lastname: Chandhoke
authors.forename: J E
authors.initials: JE
authors.lastname: Lingeman
authors.forename: J D
authors.initials: JD
authors.lastname: Denstedt
authors.forename: R
authors.initials: R
authors.lastname: Kahn
authors.forename: D G
authors.initials: DG
authors.lastname: Assimos
authors.forename: S Y
authors.initials: SY
authors.lastname: Nakada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging* / Q000628:therapy*; D007670:Kidney Calices / Q000000981:diagnostic imaging*; D008096:Lithotripsy / Q000009:adverse effects; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D011859:Radiography; D019233:Retreatment; D016896:Treatment Outcome; D018666:Ureteroscopy