ARE AUXILIARY METHODS NECESSARY PRIOR TO ESWL IN PATIENTS WITH A SOLITARY KIDNEY

Between January 1985 and October 1991, 54 patients with calculi in a s olitary kidney were treated by ESWL using the Dornier HM-3 lithotripto r. The mean age of the patiens was 53.9 years (range 24-77 years). In 51.9% of the cases the stones measured>1 cm in diameter, in 42.6% betw een 0.4 and 1 cm, and in 5.5%<0.4 cm in diameter. In 39 of the 54 pati ents (72.2%) the calculi could be disintegrated by a single ESWL treat ment. In 12 patients (22.2%) 2 ESWL treatments were necessary, and ano ther 3 patients (5.6%) needed 3 ESWL treatments. In 6 cases (11.1%) pe rcutaneous nephrostomy (PCN) was needed, and in 8 other patients urete ric stents were inserted prior to ESWL because of obstruction of the u pper urinary tract, causing impending urosepsis in 8 of these 14 cases . Following ESWL, PCN was performed in 4 cases (7.4%) and a _ ureteric stent was inserted in 2 patients (3.7%) because of urinary obstructio n. At discharge from the hospital 15 of the 54 patients (27.8%) were s tone-free and 34 patients (63.0%) had small residual fragments of <0.4 cm in diameter. One year after treatment, 42 patients could be evalua ted at a control examination. 37 of these 42 patients (88.1%) were sto ne-free and 3 patients (7.1%) showed residual fragments of <0.4 cm. In conclusion, our results demonstrate that, if there is no ureteric obs truction present prior to ESWL, the majority of patients with a solita ry kidney do not present extraordinary problems and do not need auxili ary procedures.