EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY AS FIRST LINE MONOTHERAPY OF SOLITARY CALYCEAL CALCULI

Eighty-four patients with solitary calyceal stones were treated with E xtracorporeal Shock Wave Lithotripsy (ESWL) as first line monotherapy. The indications for treatment were pain in 51 patients (61%), infecti on in 11 patients (13%), pain and infection in 18 patients (21%) and o thers in 4 patients (5%). Stone size (largest diameter) was median 9 m m (range 2-25 mm). Follow-up consisted of clinical control, isotope re nography and a plain film after 1 month; hereafter plain films after 3 and 6 months. Auxiliary procedures due to steinstrasse were performed in 3 out of 4 patients (1 nephrostomy, 1 nephrostomy + ESWL of ureter al fragments, and 1 ureteroscopic manipulation). Retreatment of the ca lyceal stone was performed in 3 patients within 6 months (2 re-ESWL, 1 lower pole resection). Stone-free (without retreatment or auxiliary p rocedures) were 26/84 (31%) after 1 month, 34/84 (40%) after 3 months and 38/84 (45%) after 6 months. Free of pain were 43/69 (62%) after 1 month, 50/69 (72%) after 3 months and 59/69 (86%) after 6 months. Free of infection were 18/29 (62%) after 1 month, 19/29 (66%) after 3 mont hs and 21/29 (72%) after 6 months. Complications included steinstrasse in 4 patients, sepsis in 3 patients, displacement of JJ stent in 2 pa tients and atrio-ventricular dissociation in 1 patient. To conclude: E SWL as first line therapy for solitary calceal calculi offers good res ults with regard to pain and clearance of infection, but leaves 55% wi th residual stone material.