Extracorporeal Shock Wave Lithotripsy in 37 Patients with Calyceal Diverticular Stone

Yoon, Seung Hwan; Moon, Young Tae

Abstract

PURPOSE: Extracorporeal shock wave lithotripsy(SWL) is considered to be a safe and efficient treatment for urinary stones, but controversies still remain for the treatment of stones in caliceal diverticula, because the anatomical factor of the stone formation persists, even when the stone itself has been resolved. For this reason, we reviewed 37 patients with calyceal diverticular stone to determine whether they could be treated successfully by SWL as the initial treatment.
MATERIALS AND METHODS
A total of 37 patients with caliceal diverticular calculi underwent SWL with EDAP-LT01, LT02 and LT02-Plus between February 1990 and June 1998. Among the 37 patients, 26 were asymptomatic and 11 were symptomatic.
RESULTS
The location of the diverticulum was right upper calyx in 12 kidneys, right middle calyx in 5, right lower calyx in 7, left upper calyx in 7, left middle calyx in 4 and left lower calyx in 2. The average stone size was 1.1cm, with a range of 0.2 to 2.5cm. A stone-free state was initially achieved in 17(45.9%) patients for 1 to 26 months (mean 5.1 months). The average number of treatments was 3.5. Additionally, a success rate of 68.8% can be achieved in the patients with radiographical patency of diverticular neck. Extended follow-up in 17 patients for 8 to 100 months (mean 47.1 months) after SWL revealed recurrent stones in only 1(5.9%). Of the 11 patients with flank pain or urinary tract infection before SWL, 8(72.7%) were relieved or markedly improved in 1 to 2 months(mean 1.3 months) after average session of 2.1. Side effects of SWL developed in 10(27%); Colic in 8(21.6%), mild fever in 1(2.7%), and severe gross hematuria in 1(2.7%).
CONCLUSIONS
We confirmed that SWL is a safe and effective method and should be considered an acceptable form of primary management for patients with calyceal diverticular stone.