Steinstrasseafter Extracorporeal Shockwave Lithotripsy: Aetiologyand Management

Abstract

Background: Renal stone is the most common disease managed by an urologist. Extracorporeal shock wave lithotripsy (ESWL) is one of main modality of management of renal stone. Steinstrasse one of complication of ESWL is not an uncommon event. Steinstrasse may be managed with conservative management, ESWL or ureteroscopy (URS) or open surgery. We describe our experience of management of steinstrasse patients in IGMC Shimla.Subjects and Methods:Extracorporeal shockwave lithotripsy (ESWL) is given to patients presenting with renal and upper ureteric stones. This study included diagnosis and management of 7 patients developing steinstrasse after ESWL.Results:All steinstrasse developed in patients of renal stone and size more than 2cm. Four patients had pain after ESWL and 3 patients were asymptomatic. Four patients had pre-ESWL DJ stenting in view of large stone, 2 patients did not require DJ stenting and one patient required DJ stenting after persistent pain. Five patients required URS at 3 weeks after an incomplete response to conservative treatment. One patient received ESWL for fragments in ureters, and 1 patient didn't require intervention.Conclusion: Stone size and site were the significant factors predicting steinstrasse formation. URS and ESWL are very effective interventions for patients not responding to conservative management