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Introduction -The treatment of renal calculi is based on various factors such as size, location, composition of stones, and associated anatomical abnormalities. Stone burden (size and number) is perhaps the single most important factor in determining the appropriate treatment modality for a patient with kidney calculi. In the kidney, for stones up to 20mm in diameter, ESWL is the recommended treatment. For stones >20mm in diameter, percutaneous nephrolithotomy (PCNL) is the first-line treatment. This is due to the higher retreatment rates and lower likelihood of achieving stone-free state with ESWL in comparison of PCNL. Most prefer to do pre-treatment prophylactic DJ stenting while treating larger renal stones (>2 cm) with ESWL due to fear of having complications.
Aims and Objectives: To evaluate the outcome of extracorporeal shock wave lithotripsy (ESWL) as monotherapy for solitary renal stones larger than 2 cm without ureteral stenting.
Materials and Methods: This was a retrospective study conducted in our department from September 2010 to February 2012.The study population were patients with nephrolithiasis with stone size more than 2 cm treated with Dornier Compact S – lithotripter (N= 208). The Study variables were age, sex, location and size of the stones. Pre-treatment KUB plain films, etc performed in all patients. Routine investigations performed. Post-treatment follow-up USG, KUB plain films were used to monitor the fragmentation and clearance of fragments. Stone size was calculated by measuring the maximum dimensions of the stone. Complete clearance defined as having no stone fragments at 3 months radiologically. Incomplete clearance was defined as having stone fragments of 5 mm or more in size. Clinically insignificant residual fragments (CIRFs) were defined as having stone fragments of 4 mm or less. Successful outcome was defined as being stone free or having CIRF at 3 months.
Results: The mean age of the patients was 43.8 years. More than 70 percent of the patients were in the age group of 30 - 60 years. The male to female ratio was 1:1.2. One hundred nineteen patients had stones on the right kidney and eighty-nine patients had on the left kidney. 24.04% patients developed skin bruises at the site of entry of shock waves which subsided themselves over few days. Mild transient hematuria was observed in 110 patients. Two (0.96%) patients developed perirenal hematoma after the fifth session. Steinstrasse was observed in 81(38.94%) patients. The overall success rate was 67.31%. There were 8 (3.85%) cases of failure to fragmentation and 60 cases of incomplete clearance.
Conclusion: With this small population, we were able to achieve the success rates comparable to larger series. A comparison study between PNL and ESWL for larger renal stones comparing stone-free rate, retreatment rate, economics of treatment, and complications after standardization of treatment schedule is needed. But in patients who are not fit for invasive surgeries like PCNL and open surgery, ESWL can be considered as a treatment option
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