Steinstrasse, prevention and management

ABSTRACT

Four hundred patients who attended stone centre were chosen with inclusion criteria and randomly allocated in two groups. Group [I] in which JJ stent was inserted prior to extracorporeal shock wave lithotripsy [ESWL] and Group [II] without JJ stent insertion. Out of these 400 patients, 38 patients developed steinstrasse [group [I] 6% and group [II] 13%]. Presenting symptoms varied from symptomless up to obstruction and sepsis. Treatment programs were not predetermined but dependant upon the hotness of progression. Follow up, ESWL to leading stone, retrograde manipulation, precutaneous nephrostomy and open surgery were attempted in this series according to certain indications. In conclusion Certain measures must be fulfilled to prevent steinstrasse formation debulking of large stone, stenting and to do shaving of the stone from distal part to facilitate regular expulsion of stone debris