📃 Paper Title: Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy
🧍 Author: Elbahnasy
🕒 Year: 1998
📚 Journal: The Journal of Urology
🌎 Country: USA
ㅤContext to the study:
What three factors have been found to decrease stone free clearance after ESWL for lower pole stones?
ㅤ✅ Take-home message of study:
This paper investigates the impact of lower pole radiographic anatomy on the clearance of lower caliceal stones after either extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS).
Three factors were found to decrease stone free clearance after ESWL for lower pole stones: An acute infundibulo-pelvic angle,
A short infundibular length, A narrow infundibular width. Spatial anatomy of the lower pole does not significantly influence stone free-rate after ureteroscopy.
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ㅤ Retrospective observational study
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Study participants:
Number included: 34
Inclusion criteria:
Solitary lower pole stone,
<15mm in greatest diameter,
Presenting from 1992 to 1996,
treated with ESWL or flexible ureteroscopy,
Pre-op IVP performed
Exclusion criteria:
Congenital anomalies of the skeleton or kidney,
Stone size >15mm at the largest diameter, Significant hydronephrosis > grade 2
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Key study outcomes:
Median follow up of 12.3 months in the URS group and 8 months in the ESWL group.
After initial therapy the overall stone-free rate was 62% in the URS group and 52% in the ESWL group.
Infundibulo-pelvic angle >90 degrees, infundibular lengthcm, and infundibular width >5 mm were each individually noted to correlate with improved stone free rates after ESWL.
These anatomical factors impact the stone free rate following ESWL. However, stone free rate following URS was not significantly impacted by these factors.
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Study Limitations:
Retrospective analysis
Small sample size
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- Question:
Do anatomic factors effect stone free clearance after ESWL for lower pole stones?
Show answer
Yes- Infundibulo-pelvic angle >90 degrees, infundibular length <3 cm, and infundibular width >5 mm were each individually noted to correlate with improved stone free rates after ESWL- Question:
Do anatomic factors effect stone free clearance after ureteroscopy for lower pole stones?