Shock wave lithotripsy in patients with renal calculi

OBJECTIVE: To demonstrate the efficacy of shock wave lithotripsy (SWL) in the primary treatment of 1647 patients with renal calculi using a Dornier Doli U/50 lithotripter.

METHODS: One thousand and six hundred forty-seven patients underwent SWL as day-cases at King Abdulaziz University Hospital in Jeddah, Saudi Arabia between October 2001 and July 2007, using intravenous sedation (Pethidine 1mg/kg and Midazolam 5-10mg) for analgesia in 85.5% of the patients. The treatment outcome of 2241 renal calculi was analyzed and stratified according to the size and the site of the stones. Recorded data included shock waves intensity, number of shocks, treatment time, analgesia, stone related factors such as size, site, number, nature, composition, and any related complications. The stones were grouped into 5 groups according to the largest stone size in the kidney. Patients were followed up for 6-18 months, mean of 13 months.

RESULTS: Complete clearance of the stones occurred in 2154 kidneys (89.5%). At 3-months follow up. The overall re-treatment rate was 57.2% and for each group it was 132 (23.5%) for Group I, 254 (36.1%) for Gourp II, 473 (85.5%) for Group III, 278 (100%) for Group IV and 147 100% for Group V. Treatment failed in 87 patients with stone size of 20-29mm in 57 patients, and in 30 patients with stone size of 30-39mm. Fifty-six were solitary pelvic stones treated with ureteroscopy, while 31 were calyceal stones treated by other modalities such as percutaneousnephro-lithotomy. The most common complication was pyelonephritis with or without obstruction.

CONCLUSION: Shock wave lithotripsy treatment was a successful primary management of renal stones of variable sizes in 89.5% of the treated kidneys.