Radiographic anatomical insights into mechanism of lower calyceal stone evacuation following ESWL

Abstract

This study was aimed to elucidate whether there is significant relationship between the lower calyceal anatomy and stone evacuation following extracorporeal shock wave lithotripsy(ESWL). From April 1995 to November 1999, 145 patients with lower caliceal stones underwent ESWL with Storz Modulith SL20 lithotriptor. The pelvicalyecal angle, lower pole infundibular length and width, and lower pole calyceal pattern of the stone-bearing calyx were measured on pre-ESWL intravenous urograms. Abdominal plain film and ultrasonography taken of all patients at the 3-month followup showed that the overall stone-free rate was 65% after 3 months. The stone-free rate was significantly correlated to the radiographic anatomical factor, 94% in patients with a pelvicalyceal angle of 90 degrees or greater, 57% in those with less than 90 degrees pelvicalyceal angle; 80% in those with infundibular length of 30 mm or less, 59% in those with infundibular length greater than 30 mm; 73% in those with infundibular width greater than 4 mm, 48% in those with infundibular width of 4 mm or less; 85% in those with a simple calyceal pattern and 41% in those with a complex one. These findings suggest that the 4 radiographic anatomical factors of the lower pole calyx (pelvicalyceal angle, infundibular length and width and calyceal pattern) play an important role in stone evacuation after ESWL. Pelvicalyceal angle of 90 degrees or greater, infundibular length of 30 mm or less and width greater than 4 mm, and simple calyceal pattern are respectively noted to relate to an improved stone-free status. In contrast, an acute pelvicalyceal angle, long infundibular length and narrow infundibular width and complex calyceal pattern are individually unfavorable factors for stone emptying following ESWL.