Efficacy of Extracorporeal Shock Wave Lithotripsy on the Treatment of Upper Urinary Tract Stones

Abstract

Objectives. Extracorporeal Shock wave Lithotripsy (ESWL) is an effective and non-invasive treatment for renal and upper ureteral stones. However, appropriate treatment for larger stones (＞2 cm) is still controversial. We aimed to investigate the efficacy of ESWL for larger upper urinary tract stones and the factors that influence outcome. Methods. From December 1999 to July 2000, a total of 703 patients with upper urinary tract stones (470 patients with renal stones and 233 patients with upper ureteral stones) were treated by ESWL at the China Medical University Hospital. One hundred seventy-five cases were excluded from this study because of missing data or because they were lost to follow up. A total of 528 patients were enrolled in this study. We analyzed the difference in outcome by dividing patients into 3 groups according to stone size: Group A＜10 mm (274 cases), Group B＜20 mm but＞10 mm (204 cases), Group C＞20 mm (50 cases). Auxiliary treatment for the complications in the 3 groups included either uretero-renoscopic lithotripsy (URSL) or percutaneous nephro-lithotripsy (PCNL). Results. An overall stone free rate of 69.7% (stone fragment＜ mm) was achieved during 3- month follow-up. The auxiliary treatment rate differed among the 3 groups (p＜0.001). Group C required a higher auxiliary treatment rate (24.0%) and had a lower stone free rate (32.0%) than the other two groups. No serious complications related to ESWL were observed. Conclusions. In conclusion, the ESWL is a safe and effective method for treating renal and upper ureteral stones. However, ESWL is not recommended for treating stones greater than 20 mm because of the higher auxiliary treatment rate and lower stone free rate.