The role of ESWL in the treatment of large kidney stones.

With extracorporeal shock wave lithotripsy firmly established as the treatment of choice for the majority of kidney stones, the management of large stone burdens and staghorn stones remains a point of discussion(1,2,3,4). Although with increasing experience the original limitations(5,6) posed by the size and the number of kidney stones have gradually become less important, most centres still approach large stones with a combination of percutaneous ultrasound lithotripsy and ESWL. This article reports on a personal series of 96 kidneys with an average stone burden of 51 mm treated by ESWL alone or in combination with indwelling ureteral drainage tubes, so called double J stents. Of these 96 kidneys, twelve were treated in one session, 74 in two, nine in three and one in four sessions. At six to twelve weeks after their last treatment session 42 were stonefree, 30 contained residual fragments smaller than 3 mm and four contained fragments larger than 3 mm. Complications were hematuria, pain, fever, encrustration of stone on the double J stent, spontaneous knotting of the double J stent and subcapsular hematoma. No kidneys were lost in this series and no deaths occurred. The results are comparable to those of combined PCN and ESWL(1). A case is made for ESWL with internal drainage by double J stent as the only auxiliary measure in kidneys with large stone burdens(7,8).