Effectiveness of SWL for lower-pole caliceal nephrolithiasis: evaluation of 452 cases.

The authors report on the treatment of lower-pole caliceal nephrolithiasis with extracorporeal shockwave lithotripsy (SWL) using the Czech-made Medilit M-5 lithotripter. In 310 patients, they have performed 452 treatments and evaluated the results 3 months after the last session using plain radiographs and ultrasound examination. The effectiveness of treatment and the success rate of SWL decreased with increasing size of stones: with stones >20 mm, it declined to 30%. This poor success rate was attributable not only to the size of the concrement, but also to its location in a lower calix, which is unfavorable for the passage of fragments. For big lower-pole caliceal stones (>20 mm in the longest diameter), the authors recommend percutaneous nephrolithotomy as the primary management method, the effectiveness of which does not depend on the size of the stone. The success rate achieved in treating the lower-pole caliceal lithiasis using the Medilit M-5 machine was 61.3%, similar to that achieved with other lithotripters.

[Effective treatment of nephrolithiasis of the lower calix using ESWL (evaluation of 452 procedures)]. / Efektivnost resení nefrolitiázy dolního kalichu metodou ESWL (zhodnocení 452 výkonu).

The authors present their results with the treatment of nephrolithiasis of the lower calix using the method of extracorporeal lithotripsy with the Czech apparatus Medilit M-5. In 310 patients they made 452 operations and checked the therapeutic results three months after the last session. For checking they used a native nephrogram and examination by ultrasound. With the increasing size of concrements the effectiveness declined and thus also the success of ESWL(in concrements above 20 mm in size it declined to 30%). This is not due only to the size of the concrement but also its site in the lower calix which is unfavourable for the elimination of fragments after ESWL. The authors recommend therefore in large concrements of the lower calix (more than 20 mm in the longitudinal axis) to select as the primary method percutaneous nephrolithotomy which is highly effective in this localization and is independent on the size of the concrement. The general success rate achieved in treatment of lithiasis of the lower renal calix with Medilit M-5 is 61.3% and is comparable with other lithotriptors.