RENAL STONE FRAGMENTS FOLLOWING SHOCK-WAVE LITHOTRIPSY

Purpose: We describe a select group of asymptomatic patients with frag ments and dust 3 months after extracorporeal treatment, who were follo wed to evaluate the long-term outcome and therapeutic implications. Ma terials and Methods: A total of 129 patients with dust and residual fr agments (less than 4 mm.) at 3 months was re-examined at 12 months, an d 95 were also evaluated at 24 months. Followup examinations consisted of radiographic studies, renal ultrasonography and urine culture. Dus t and residual fragments were sought, and patients were defined as fre e or as having persistent lithiasis or stone regrowth. At 24 months re currences in the patients stone-free at 12 months also were considered . Results: At the 12-month followup 60 patients (46.5%) were stone-fre e and 56 (43.5%) still had dust or residual fragments. The localizatio n of the stones or fragments at 3 months and their sizes did not have a significant influence on the stone-free rate but regrowth was greate r in patients with stones larger than 10 mm. (11 of 40 patients, 27.5% versus 2 of 89, 2.2%, p = 0.001). The probability of eliminating resi dual lithiasis at 12 months was significantly greater in patients with dust than in those with residual fragments (42 of 79 patients, 58% ve rsus 18 of 50, 36%, p = 0.026). Regrowth of residual lithiasis was obs erved in 13 patients (10%). Conclusions: Based on our results, we do n ot believe that patients with fragments require systematic re-treatmen t in the short term but they may be followed long term and re-treated if symptoms persist or stones recur.