Natural history of residual renal stone fragments after ESWL

Objective: After extracorporeal shock wave lithotripsy (ESWL), residual fra gments (RF) 4 mm or less are usually considered as clinically insignificant . We retrospectively reviewed the natural history and clinical significance of 97 noninfected and isolated RF (4 mm or less) observed 3 months after t he last ESWL session on renal tomography. Patients and Methods: They represented 83 among 1,216 patients treated by E SWL over a 9-year period (1989-1997). These RF were mostly localized in the inferior calyx (62%). Median follow-up was 40.6 months (range: 7-96 months ). Renal tomography was always performed at the end of follow-up. Results: Stone-free status, or a decreased, stable or increased amount of r esidual stone occurred in 27 (33%), 1 (1%), 24 (29%) and 31 (37%) of the 83 patients, respectively. During this study, 18 patients (22%) were proposed for a complementary treatment related to a size increase of the residual f ragments (13 ESWL, 1 retrograde endoscopy, 3 percutaneous nephrolithotomy, and 1 polar inferior nephrectomy). Conclusion: The term clinically insignificant should not be employed to des cribe RF after ESWL. Efforts should be performed to obtain true stone-free status after ESWL. Copyright (C) 2000 S. Karger AG, Baser.