Lithotripsy Suitable for Lower Pole Stones

Extracorporeal shockwave lithotripsy (ESWL) has favorable efficacy in the treatment of lower pole renal stones, according to researchers.

Helen Cui, MD, and colleagues at The Churchill Hospital in Oxford, U.K., evaluated the use of ESWL in 50 patients with lower pole kidney stones 15 mm or less in diameter. The researchers defined clinical success as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) at radiological follow-up. Subjects had a mean stone size of 7.8 mm, with 66% of the stones 5-10 mm in diameter and 28% of stones 10-15 mm in diameter.

For solitary lower pole stones, complete stone clearance was achieved in 63% of cases, the investigators reported online ahead of print in Urolithiasis. Total stone clearance (either complete clearance or CIRFs) was achieved in 81% of patients. Among patients with multiple stones, success rates were lower: complete clearance occurred in 54% of patients and total stone clearance was achieved in 72%.

Dr. Cui's group commented that their outcome data for the treatment of lower pole renal stones 15 mm or smaller compare favorably with the literature.

“With this level of stone clearance, a non-invasive, outpatient-based treatment like lithotripsy should remain the first-line treatment option for lower pole stones,” the authors concluded. “Ureteroscopy must prove that it is significantly better in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.”

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