EXTRACORPOREAL SHOCKWAVE THERAPY FOR UROLITHIASIS WITH RENAL-INSUFFICIENCY

Management of urolithiasis with renal insufficiency poses a multidimen sional nephrourological situation. Sixty-two patients of potentially r eversible calculus obstructive nephropathy and azotemia were treated w ith extracorporeal shockwave lithotripsy (ESWL) on the Siemen's Lithos tar. These patients were treated under sedoanalgesia after the initial therapeutic ureteral stenting. Satisfactory fragmentation was achieve d in all the patients. The incidence of major complications was 3.2% w ith an 85% stone-free rate at 6 months. Pre- and post-ESWL hemodialysi s was required in 14 and 3 patients, respectively. All patients had va riable levels of improvement in the renal function. Proper selection o f cases is mandatory for satisfactory outcome. The combination of uret eral stenting followed by phased ESWL represents an attractive alterna tive to traditional surgical management of stones with renal insuffici ency.