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Inicio Actas Urológicas Españolas (English Edition) Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatme...
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Vol. 47. Issue 10.
Pages 688-693 (December 2023)
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Vol. 47. Issue 10.
Pages 688-693 (December 2023)
Resident section
Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatment success
Litotricia extracorpórea por ondas de choque (LEOCh) Para litiasis de grupo calicial inferior: ¿cómo predecir el éxito del tratamiento?
M. Mata Alcaraz
Corresponding author
marinavln10@gmail.com

Corresponding author.
, I. Laso García, C. Mínguez Ojeda, A. Artiles Medina, G. Duque Ruiz, M. Hevia Palacios, F. Arias Fúnez, F.J. Burgos Revilla
Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Tables (2)
Table 1. Stone characteristics, anatomy and SFR.
Table 2. Factors associated with 2nd treatment.
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Abstract
Introduction

The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones.

Methods

Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3 mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment.

Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used.

Results

512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p = 0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p = 0.000), size of the stone (p = 0.001), number of shock waves (p = 0.003), energy applied (p = 0.038) and the need for additional treatment after ESWL.

Conclusions

ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.

Keywords:
Urolithiasis
Extracorporeal shock wave lithotripsy
Lower renal calyx
Stone-free rate
Resumen
Introducción

El uso de la litotricia extracorpórea por ondas de choque (LEOCh) en litiasis de grupo calicial inferior (GCI) se asocia con una alta tasa de fragmentos residuales. Nuestro objetivo es analizar la efectividad y complicaciones del tratamiento con LEOCh en litiasis de GCI.

Métodos

Revisión retrospectiva de pacientes con litiasis en GCI tratadas con LEOCh entre enero 2014 y Diciembre 2020. Se determina anatomía favorable del GCI mediante longitud infundibular, ancho infundibular y ángulo infundibulopélvico. Se considera fracaso de LEOCh la presencia de fragmentos >3 mm en radiografía simple, TC o ecografía a los 3 meses del procedimiento.

Análisis de complicaciones, procedimientos auxiliares y factores de riesgo asociados con hematoma perirrenal. Análisis estadístico mediante software SPSS.

Resultados

En total, 512 pacientes con litiasis en GCI fueron tratados con LEOCh. El 80.3% de los pacientes tenía anatomía GCI favorable. La tasa libre de litiasis (TLL) fue 70.5%. Las principales complicaciones fueron: calle litiásica (5 pacientes) e infección del tracto urinario (3 casos). Se describen 10 hematomas perirrenales (2%). La toma de antiagregantes mostró asociación estadística con el riesgo de hematoma perirrenal (p = 0.004). Mediante regresión logística binaria se demuestra asociación entre anatomía desfavorable del GCI (p = 0.000), tamaño de litiasis (p = 0.001), número de ondas de choque (p = 0.003), energía aplicada (p = 0.038) y necesidad de tratamiento adicional tras LEOCh.

Conclusiones

El tratamiento con LEOCh puede ser considerado de primera elección en litiasis de GCI. El tamaño de la litiasis, anatomía calicial desfavorable, número de ondas de choque y energía utilizadas pueden predecir la necesidad de retratamiento.

Palabras clave:
Urolitiasis
Litotricia extracorpórea por ondas de choque
Grupo calicial inferior
Tasa libre de litiasis

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