How significant are clinically insignificant residual fragments following lithotripsy?
OBJECTIVE
Extracorporeal shock-wave lithotripsy had revolutionized the treatment of kidney stones. Residual fragments smaller than 4 or 5 mm which are asymptomatic and likely to pass spontaneously are termed as clinically insignificant residual fragments. This article reviews the current literature with regards to the management of clinically insignificant residual fragments.


RESULTS
However, the term is controversial because no consensus has been reached regarding its exact definition or interval after extracorporeal shock-wave lithotripsy to evaluate its presence. While most small residual stone fragments might be managed expectantly, a significant number of patients might become symptomatic or require intervention. These so-called clinically insignificant residual fragments have the potential to cause obstruction and are important risk factors for stone recurrence and re-growth.


CONCLUSIONS
Residual fragments require close monitoring for stone growth, potential complications and subsequent intervention. Secondary procedures may be applied selectively to those patients who have significant symptoms of obstruction associated with the residual stone. Medical therapy might play an important role in the management of residual fragments.
Tan
Yeh Hong
YH
Department of Urology, Singapore General Hospital, Outram Road, Singapore 169-608, Singapore. gurtyh@sgh.com.sg
Wong
Michael
M
D006801:Humans; D007669:Kidney Calculi / Q000473:pathology* / Q000601:surgery*; D008096:Lithotripsy; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D009626:Terminology as Topic