Stone street after extracorporeal shock wave lithotripsy: Changing trends upon changing lithotripsy indications


Küpeli B., Gürocak S., Irkilata L., Tunç L., Karaoǧlan Ü., Bozkirli I.

Gazi Medical Journal, vol.14, no.3, pp.103-107, 2003 (Scopus) identifier

  • Publication Type: Article / Article
  • Volume: 14 Issue: 3
  • Publication Date: 2003
  • Journal Name: Gazi Medical Journal
  • Journal Indexes: Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.103-107
  • Keywords: Lithotripsy, Stone-Street, Ureteroscopy, Urolithiasis
  • Gazi University Affiliated: Yes

Abstract

Purpose: One of the main complications of extracorporeal shock wave lithotripsy (ESL) is the formation of stone streets. Although this complication may result in the spontaneous passage of stone fragments with urine, it may cause partial or full obstruction of the urinary system and affect renal functions. In this study, we evaluate the occurrence of stone streets and our clinical approach regarding the changing trends in both ESL and stone-street treatments in the 1990-1998 and 1998-2002 periods. Methods: Between April 1990 and December 2002, 6300 patients underwent ESL with a Siemens Lithostar Plus lithotriptor. Of these, 360 (5.7%) patients were found to have stone streets during their treatment; however, 50 (13.8%) patients were excluded from the study due to irregular follow-up. Mean length of the stone streets was 2.95 (1-15.2) cm. Results: Between 1990 and 1998, 256 (6.1%) patients had stone streets, whereas, between 1998 and 2002, 104 (4.9%) stone streets were observed. Of these patients, spontaneous relief was attained in 133 (43.1%) patients while additional ESL was necessary in 149 (48%) patients. Twenty (6.5%) and 8 (2.6%) patients in whom ESL was unsuccessful underwent ureterorenoscopy and ureterolithotomy, respectively. While the clearance rate ofstone streets in the proximal ureter with spontaneous passage or ESL was 25% and 63.7%, these rates were 27.2% and 59.2% in the middle ureter and 51.4% and 40.8% in the distal ureter, respectively. Invasive procedures were performed in 4.1% of patients with a stone surface area less than 3 cm2; however, this rate increased to 20.4% in patients with a stone surface area larger than 3 cm 2. Also in this subgroup of patients, the need for invasive measures decreased from 20.8% to 14.3% between the 1990-1998 and 1998-2002 periods. Conclusion: Patients with stone street formation should be observed carefully. Ureterorenoscopy in stone street patients is the method of choice if ESL remains unsuccessful, and open surgery may be necessary in rare complicated cases. Treatment modalities other than ESL should be considered, especially if the pre-ESL stone surface area is larger than 3 cm2.