title: Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?
abstract: Extracorporeal shock wave lithotripsy (ESWL) is an established modality for renal calculi. Its role for large stones is being questioned. A novel model of temporary double J (DJ) stenting followed by ESWL was devised and outcomes were assessed.
  
  
  
  The study included 95 patients with renal calculi sized 1 to 2 cm. Patients were randomized into 3 groups. Group 1 received ESWL only, whereas group 2 underwent stenting followed by ESWL. In group 3, a distinct model was applied in which the stent was kept for 1 week and then removed, followed by ESWL. Procedural details, analgesic requirements, and outcome were analyzed.
  
  
  
  Eighty-eight patients (male, 47; female, 41) were available for analysis. The patients' mean age was 37.9±10.9 years. Stone profile was similar among groups. Group 3 received fewer shocks (mean, 3,155) than did group 1 (mean, 3,859; p=0.05) or group 2 (mean, 3,872; p=0.04). The fragmentation rate was similar in group 3 (96.7%) and groups 1 (81.5%, p=0.12) and 2 (87.1%, p=0.16). Overall clearance in group 3 was significantly improved (83.3%) compared with that in groups 1 (63.0%, p=0.02) and 2 (64.5%, p=0.02) and was maintained even in lower pole stones. The percentage successful outcome in groups 1, 2, and 3 was 66.7%, 64.5%, and 83.3%, respectively (p=0.21). The analgesic requirement in group 2 was higher than in the other groups (p=0.00). Group 2 patients also had more grade IIIa (2/3) and IIIB (1/2) complications.
  
  
  
  Stenting adversely affects stone clearance and also makes the later course uncomfortable. Our model of brief stenting followed by ESWL provided better clearance, comfort, and a modest improvement in outcome with fewer sittings and steinstrasse in selected patients with large renal calculi.
authors.affiliation: Department of Urology, SMS Medical College and Hospital, Jaipur, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Urology, R G Kar Medical College and Hospital, Kolkata, India.
authors.forename: Arpan
authors.initials: A
authors.lastname: Choudhary
authors.affiliation: Department of Urology, R G Kar Medical College and Hospital, Kolkata, India.
authors.forename: Ranjit Kumar
authors.initials: RK
authors.lastname: Das
authors.affiliation: Department of Urology, R G Kar Medical College and Hospital, Kolkata, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Basu
authors.affiliation: Department of Urology, R G Kar Medical College and Hospital, Kolkata, India.
authors.forename: Ranjan Kumar
authors.initials: RK
authors.lastname: Dey
authors.affiliation: Department of Urology, R G Kar Medical College and Hospital, Kolkata, India.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Urology, R G Kar Medical College and Hospital, Kolkata, India.
authors.forename: Partha Pratim
authors.initials: PP
authors.lastname: Deb
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Adult; Kidney calculi; Lithotripsy; Stents