ESWL for management of steinstrasse

Hong, Jong Woo; Shin, Se Jong; Choi, Sung Hyup

Abstract

Early in the experience of ESWL, steinstrasse was recognized as potential complication and suggestions for management were proposed. including retrograde ureteral manipulation. placement of ureteral stent or percutaneous nephrostomy, etc. Recently ESWL has been challenged due to less invasive and safer procedure. We experienced 18 cases (2.1%) of steinstrasse in 850 patients with ESWL (EDAP LT-01) from February, 1989 to February, l99l and treated with ESWL. The results were obtained as follows. 1. The primary stones in 18 cases of steinstrasse were renal stones in l7 cases (complete staghorn calculi; 4 cases. partial staghorn calculi; 5 cases) and upper ureteral stone in 1 case: 2. The sites of steinstrasse were lower ureter in 13 cases and upper ureter in 5 cases. The lengths of steinstrasse were 1.4~8.3cm (mean: 3.19cm). The site and length of steinstrasse were not related with clinical symptoms. 3. Of l8 cases. 13 cases were type 1. 3 cases type II and 2 cases type III. Type of steinstrasse was not related with clinical symptoms. 4. Six cases were asymptomatic and 3 cases of symptomatic steinstrasse required hospitalization. 5. Fifteen cases were treated with ESWL only and 2 cases of solitary kidney were treated with ESWL, after percutaneous nephrostomy. Early experienced 1 case was treated with ureteroscopic removal of stone. 6. Of 17 cases treated with ESWL, stone fragments expelled out within 1 month in 13 cases, 2 months in 3 cases and 4 months in 1 case of solitary kidney. All symptoms of steinstrasse were relieved within 3 days after ESWL.