title: Does ureteral stenting prior to shock wave lithotripsy influence the need for intervention in steinstrasse and related complications?
abstract: 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.
authors.affiliation: Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan. hammad.ather@aku.edu
authors.forename: M H
authors.initials: MH
authors.lastname: Ather
authors.forename: B
authors.initials: B
authors.lastname: Shrestha
authors.forename: A
authors.initials: A
authors.lastname: Mehmood
mesh_terms: 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