Analysis of the Results of Extracorporeal Lithotripsy (ECL) in the Treatment of Stones of the Inferior Calcific Group (ICG): Does Variability in Calicial Anatomy Influence Them?

Abstract

Introduction: Lower calyceal stones always pose a problem of optimal management: the results of ESWL are insufficient, with the possibility of generating a large quantity of residual fragments and recourse to complementary treatments. The different anatomical varieties of the lower calcific group can vary the results of treatment at this site. The objective of the study is to analyze the influence of the anatomy of the lower calyceal group (LCG) on the results of ESWL. Materials: A prospective observational study involving 57 patients with LCG stones who were treated by ESWL in our department between January 2021 December 2022 according to the French recommendations of the AFU lithiasis committee. Unfavorable LCG anatomy was defined according to Sampaio's criteria: a length of the inferior stem caliceal lower >10 mm, a width<5 mm and an infundibulo-pelvic angle < 90º. Fragment-free rate was assessed 3 months after ESWL with tomography urography (CTU). Failure was considered as the existence of fragments ≥ 3mm, the need for ancillary procedures after ESWL (ureterscopy, RIRS, PCNL or new ESWL), complications and risk factors associated with the development of perirenal hematoma were analyzed. Results: The median age was 48,5 years (range: 22-68), with 66,66% of the participants being men (38 men and 19 women). Approximately 14,03 % (n=8) of the patients were taking antiplatelet/anticoagulant drugs, and 8,77 % (n= 5) had High blood pressure. The median size of the lithiasis was 10 mm (range: 5-20 mm), with favorable LCG anatomy observed in 45,61 % (n= 26/57) of patients, including 34,61 % (n= 9/26) who required ancillary procedures after ESWL, compared to 64,51% (n= 20/31) in patients with unfavorable anatomy (54,39 % = 31/57). The stone-free after ESWL for both groups combined was 54,38 % (n= 31/57). Auxiliary procedures included ureteroscopy or RIRS. Two perirenal hematomas were observed in patients on antiplatelet/anticoagulant therapy, with a favorable outcome. ...