Repeated ESWL Treatment on Steinstrasse

Lee, Hyung Seok; Park, Kwang Sung; Min, Byung Kap

Abstract

We analyzed the incidence and treatment of steinstrasse in 470 patients(renal units-521 cases) who underwent ESWL treatment for renal stones using a Piezolith 2300 piezoelectric lithotriptor between April 1990 and July 1993. Of 521 renal stones, a total of 44 cases(8.5%) developed steinstrasse. The most common location for steinstrasse was in the lower ureter(72.7%), followed by upper ureter(22.7%) and mid-ureter(4.6%). In these 44 cases, stone fragments passed spontaneously in 23 cases(52.3%) and mean duration to spontaneous passage was 15.7 days(range 1-43 days). Repeated ESWL was performed on steinstrasse in 20 cases. Successful treatment (no residual stone fragments in the ureter) was achieved in 18 cases(90%) and the mean number of sessions was 1.3. There was no significant complication after repeated ESWL. Only 2 patients who failed ESWL treatment required open ureterolithotomy. The remained 1 patient with mid-ureteral steinstrasse underwent ureteroscopic management. With this result, repeated ESWL seems to be effective and safe in the treatment of steinstrasse which is not expected to pass spontaneously.