Investig Clin Urol.  2017 Mar;58(2):103-108. 10.4111/icu.2017.58.2.103.

Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?

• Sharma R
• Choudhary
• Das RK
• Basu S
• Dey RK
• Gupta R
• Deb PP

• KMID: 2368475
• DOI: http://doi.org/10.4111/icu.2017.58.2.103

Abstract

PURPOSE
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.
MATERIALS AND METHODS
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.
RESULTS
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.
CONCLUSIONS
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.

Keyword

Adult; Kidney calculi; Lithotripsy; Stents

MeSH Terms

Adult
Female
Humans
Kidney Calculi*
Lithotripsy*
Shock*
Stents*

Figure

• 

  Fig. 1 Number of shocks given in the different groups. Group 1, received extracorporeal shock wave lithotripsy (ESWL) only; group 2, DJ Stenting was done one week prior to the ESWL; group 3, stent was kept for 1 week and then removed, followed by ESWL.

• 

  Fig. 2 Percentage of cases undergoing the given number of lithotripsy sittings in the different groups. Group 1, received extracorporeal shock wave lithotripsy (ESWL) only; group 2, DJ Stenting was done one week prior to the ESWL; group 3, stent was kept for 1 week and then removed, followed by ESWL.

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