Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy
Int. braz. j. urol
;
37(4): 477-482, July-Aug. 2011. tab
Article
in English
| LILACS
| ID: lil-600812
ABSTRACT
PURPOSE:
Urinary stone disease is a common medical problem. Extracorporeal shockwave lithotripsy (SWL) has been applied with high success and low complication rates. Steinstrasse (SS) is a possible complication after SWL. The aim of the present study was to prospectively evaluate the factors and outcomes associated with SS after SWL. MATERIALS ANDMETHODS:
We have prospectively evaluated 265 SWL sessions (2005-2009). Two lithotriptors were used randomly Siemens Lithostar and Dornier Compact S. All patients had imaging exams after 30 and 90 days or according to symptoms.RESULTS:
SS was observed in 14 (5.3 percent) out of 265 SWL procedures (n = 175 patients, 51.5 percent women/48.5 percent men, mean ± SD age = 46.3 ± 15.5 years). SS was more common after SWL for pelviureteral calculi rather than caliceal stones (p = 0.036). There was a trend toward more occurrences of SS after SWL for larger stone area (> 200 mm², p = 0.072). Preoperative ureteral stent didn't prevent SS. SWL machine, intensity, number of pulses and frequency were not associated with SS formation. Post-SWL pain, fever and gravel elimination were factors associated with SS (p = 0.021; p = 0.011; p = 0.078). When SS occurred, treatment modalities included Medical Expulsive Therapy (MET), ureteroscopy and SWL.CONCLUSIONS:
Steinstrasse is an uncommon event after SWL and seems to occur more frequently with larger pelviureteral stones. Impaction of stones is more frequent in the middle ureter. All patients should be followed after SWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever. When SS occurs, treatment should be promptly introduced, including medical expulsive therapy, surgical approach or SWL in selected cases. Further prospective studies are awaited to evaluated preventive measures for SS occurrence.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Ureteral Obstruction
/
Lithotripsy
/
Kidney Calculi
/
Ureteral Calculi
Type of study:
Etiology study
/
Observational study
/
Prognostic study
/
Risk factors
Limits:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
English
Journal:
Int. braz. j. urol
Journal subject:
Urology
Year:
2011
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
ABC Medical School/BR
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