LIMITATIONS OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR LOWER CALICEAL STONES - ANATOMIC INSIGHT

In addition to gravity-dependent position, we suppose that other parti cular anatomic features may be important in the retention of stone deb ris in lower calices after extracorporeal shockwave lithotripsy (SWL). We analyzed the inferior-pole collecting system anatomy in 146 three- dimensional polyester resin corrosion endocasts of the pelviocaliceal system. In 74% of the cases, there was an angle of greater than 90-deg rees formed between the lower infundibulum and the renal pelvis, and i n 26%, the angle was 90-degrees or less. In 60%, there was a lower inf undibulum 4 mm or larger in diameter. The inferior pole was drained by multiple calices disposed in two rows in 57% of the cases and by one midline caliceal infundibulum in 43%. We believe that the physician mu st appreciate these anatomic features when considering SWL to treat ca lculi located in lower calices.