Lower-pole caliceal stone clearance after shockwave lithotripsy, percutaneous nephrolithotomy, and flexible ureteroscopy: impact of radiographic spatial anatomy.
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.
Elbahnasy
A M
AM
Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Clayman
R V
RV
Shalhav
A L
AL
Hoenig
D M
DM
Chandhoke
P
P
Lingeman
J E
JE
Denstedt
J D
JD
Kahn
R
R
Assimos
D G
DG
Nakada
S Y
SY
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