Does ureteral stenting prior to shock wave lithotripsy influence the need for intervention in steinstrasse and related complications?
OBJECTIVE
To analyze factors affecting steinstrasse (SS) and study the impact of pre-shock wave lithotripsy (SWL) stenting in the prevention of SS and related complications.


METHODS
The cohort included 4,644 patients with renal stones treated by SWL. Three hundred and twenty-six (7%) developed SS. Initially, all patients were managed conservatively (group 1); interventions were reserved for those in whom conservative treatment failed (group 2). The 2 groups were further analyzed to identify factors influencing the need for intervention. The impact of pre-SWL stenting on the development of SS and the need for intervention was also assessed.


RESULTS
Expectant management was successful in 176 (54%) patients, while 150 (46%) required intervention for SS. The size of the stones had a significant association with the number of sessions required (p < 0.01) and the development of SS. The placement of a stent prior to SWL decreased neither the sessions of SWL (p < 0.01) nor the interventions required for SS and related complications.


CONCLUSIONS
SWL for larger stones is a potentially significant complication of SWL and is associated with significant morbidity. Ureteral stents decrease the acute presentations of patients with SS; however, it does not decrease the ultimate need for intervention in the management of SS.
Ather
M H
MH
Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan. hammad.ather@aku.edu
Shrestha
B
B
Mehmood
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications* / Q000628:therapy*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D014513:Ureter / Q000601:surgery*; D014514:Ureteral Calculi / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult