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Management of calyceal diverticular stones with extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy: long‐term outcome
Author(s) -
Turna Burak,
Raza Asif,
Moussa Sami,
Smith Gordon,
Tolley David A.
Publication year - 2007
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2007.06911.x
Subject(s) - medicine , extracorporeal shock wave lithotripsy , percutaneous nephrolithotomy , surgery , lithotripsy , asymptomatic , lithotomy position , percutaneous , alternative medicine , pathology
In this section this month, we have two papers. The first is from authors from Scotland. They present a review of patients with an extended follow‐up who have undergone extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) for calyceal diverticular stones over a 15‐year period to assess long‐term outcome, irrespective of treatment. They concluded that PCNL is an effective and durable means of treating calyceal diverticular stones, regardless of stone size or location of the diverticulum. Despite low stone‐free rates with ESWL, most patients are rendered symptom‐free with minimal complications. The second paper is from the USA; the authors discuss the new generation of flexible ureteroscopes, which provide exaggerated active deflection to facilitate intrarenal manipulation. They compared the relative ease of manipulation around a calyceal model. The authors concluded that the Wolf Viper proved superior for manipulation in the hands of experienced endoscopists. OBJECTIVE To review patients with an extended follow‐up after extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) for calyceal diverticular stones (CDS), over a 15‐year period, assessing the long‐term outcome. PATIENTS AND METHODS In all, 56 patients were treated for symptomatic CDS disease by ESWL (38) or PCNL (18). The stone‐bearing diverticula were in the upper calyces in 26, middle calyces in 24 and lower calyces in six patients, and in the right kidney in 22 and in the left in 34. The most frequent symptom was ipsilateral flank pain (84%) and 32% of patients presented with associated chronic urinary tract infections. In a retrospective analysis, we assessed stone size, diverticulum location, stone‐free rate, symptom‐free rate, complications and extended follow‐up. RESULTS In the short‐term in the ESWL group, 21% of patients were stone‐free and 61% were asymptomatic; 8% developed symptoms and 8% developed recurrence or stone‐growth in the long term. There were six minor complications. In the PCNL group, 15 patients (83%) were stone‐free in the short term; two had a recurrence (11%) and two had stone growth (11) in the long term. There were three complications after PCNL. CONCLUSIONS This series shows that PCNL is an effective and durable means of treating CDS, regardless of stone size or location of the diverticulum. Despite low stone‐free rates with ESWL, most patients were rendered symptom‐free with minimal complications. The long‐term recurrence rates, 8% for ESWL and 11% for PCNL, were comparable.