Treatment of renal stones by extracorporeal shockwave lithotripsy - An update

Aim: Despite the extensive experience with minimal invasive stone therapy, there are still different views on the ideal management of renal stones. Materials and Methods: Analysis of the literature includes more than 14,000 patients. We have compared these data with long-term results of two major stone centers in Germany. The results have been compared concerning the ana tomical kidney situation, stone size, stone localization and observation ti me. Results: According to the importance of residual fragments following extrac orporeal shock wave lithotripsy (ESWL), we have to distinguish between clin ically insignificant residual fragments and clinically significant residual fragments (CIRF). 24 months following ESWL stone passage occurs as a conti nous process, and if there are no clinical symptoms, any endoscopic procedu re should be considered as overtreatment. According to these results, stone -free rates of patients increase in longer follow-up periods. Newer ESWL te chnology has increased the percentage of CIRF. Conclusion: We consider ESWL in most patients with renal calculi as first-l ine treatment, except in patients with renal calculi bigger than 30 mm in d iameter. Copyright (C) 2001 S. Karger AG, Basel.