[Current indications of percutaneous nephrostomy associated with extracorporeal shock wave lithotripsy in the treatment of renoureteral stones]. / Indicaciones actuales de la nefrostomía percutanea asociada a la litotricia extracorpórea por ondas de choque en el tratamiento de la litiasis reno ureteral.

ABSTRACT

OBJECTIVES: To evaluate the usefulness of PN as urinary diversion in the treatment of urinary stones by ESWL. METHODS: Between April 1996 and June 2003 9554 ESWL were performed at the lithiasis unit of the Fundación Jiménez Diaz; 0.91% required previous insertion of a PN. We performed a retrospective analysis of the 49 patients with the diagnosis of upper urinary tract stones who require treatment by ESWL associated with PN. Indications for PN were ureteral obstruction by fragments 6%, treatment of residual stones after percutaneous nephrolithectomy 6%, ureteral obstruction by a calcified double J stent 5%, urinary sepsis 75%, and obstructive anuria in a solitary kidney 8%. RESULTS: Overall, 87 sessions were performed in 49 patients. Number of shock waves 3996, Kv 7.69. Results where comparable in terms of stone size and composition. 57% of the patients were stone-free after one session, 24% after 2, and 19% required more than 2 sessions. There were two failures requiring surgery. CONCLUSIONS: Although in-situ ESWL is the treatment of choice for renoureteral lithiasis, the PN is a complementary procedure when ureteral obstruction requires treatment; it is non invasive and may be successfully associated to ESWL.