title: Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy.
abstract: OBJECTIVE
  Urinary stone disease is a common medical problem. Extracorporeal shockwave lithotripsy (SWL) has been applied with high success and low complication rates. Steinstrasse (SS) is a possible complication after SWL. The aim of the present study was to prospectively evaluate the factors and outcomes associated with SS after SWL.
  
  
  METHODS
  We have prospectively evaluated 265 SWL sessions (2005-2009). Two lithotriptors were used randomly: Siemens Lithostar and Dornier Compact S. All patients had imaging exams after 30 and 90 days or according to symptoms.
  
  
  RESULTS
  SS was observed in 14 (5.3%) out of 265 SWL procedures (n = 175 patients, 51.5% women/48.5% men, mean ± SD age = 46.3 ± 15.5 years). SS was more common after SWL for pelviureteral calculi rather than caliceal stones (p = 0.036). There was a trend toward more occurrences of SS after SWL for larger stone area (> 200 mm², p = 0.072). Preoperative ureteral stent didn't prevent SS. SWL machine, intensity, number of pulses and frequency were not associated with SS formation. Post-SWL pain, fever and gravel elimination were factors associated with SS (p = 0.021; p = 0.011; p = 0.078). When SS occurred, treatment modalities included Medical Expulsive Therapy (MET), ureteroscopy and SWL.
  
  
  CONCLUSIONS
  Steinstrasse is an uncommon event after SWL and seems to occur more frequently with larger pelviureteral stones. Impaction of stones is more frequent in the middle ureter. All patients should be followed after SWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever. When SS occurs, treatment should be promptly introduced, including medical expulsive therapy, surgical approach or SWL in selected cases. Further prospective studies are awaited to evaluated preventive measures for SS occurrence.
authors: Division of Urology, ABC Medical School, Santo André, SP, Brazil.
authors: Jarques
authors: J
authors: Lucio
authors: Fernando
authors: F
authors: Korkes
authors: Antonio Corrêa
authors: AC
authors: Lopes-Neto
authors: Edward Gomes
authors: EG
authors: Silva
authors: Mário Henrique Elias
authors: MH
authors: Mattos
authors: Antonio Carlos Lima
authors: AC
authors: Pompeo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D014517:Ureteral Obstruction / Q000209:etiology*; D055815:Young Adult