Abstract
Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.
Highlights
The use of Extracorporeal shockwave lithotripsy (ESWL) for the management of renal and upper urinary tract calculi started as far back as the 1980’s [1].ESWL is a very important and highly effective method in the treatment of calculi of the upper urinary tract and upper ureter
We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm
The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm
Summary
ESWL is a very important and highly effective method in the treatment of calculi of the upper urinary tract and upper ureter. It effectively fragments these calculi, which in turn pass completely by the end of 3 months in 77.4% of the patients with single stones according to a report by Drach et al in 1986 [2]. Other non-invasive methods are employed in the management of calculi of the upper urinary tract and upper ureter. These include percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), laparoscopy and robotic surgery [4]. Because of limited resources in our setting and coupled with the expensive nature of PCNL in terms of equipment and expertise, ESWL is still being performed on patients with renal stone size above 20 mm
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