The role of extracorporeal shockwave lithotripsy in an asymptomatic special patient group with small renal calculi

Background and Purpose: Data concerning extracorporeal shock wave lithotripsy (SWL) management of small (≤5 mm) asymptomatic renal caliceal stones are lacking in the literature. In this study, we aimed to determine the effectiveness of SWL in a special group of patients who had very small (≤5 mm) asymptomatic renal caliceal stones. The group of patients consisted of pilots, gendarmes, and soldiers, such as commandos, for whom treatment was obligatory and who had to be stone free because of their military duties. Patients and Methods: We retrospectively examined SWL data and retrieved information for 84 patients with small asymptomatic renal caliceal stones. The SWL sessions were performed with a Siemens Lithostar lithotriptor. The mean age of the patients was 34 ± 13 years. The mean stone size was 4.8 ± 0.4 mm. The mean numbers of shockwaves and energy used were 2707 ± 1742 and 18 ± 2 kV, respectively. The location of stones were: 11 right upper calix, 10 right middle calix, 17 right lower calix, 13 left upper calix, 16 left middle calyx, and 17 left lower calix. Eighty-four patients underwent 101 SWL sessions. Only eight patients had second and three patients had third SWL treatments. SWL was performed five times for only one patient. All mean values were realized with an SPSS 10.0 statistical program. Results: After the first, second, and third SWL sessions, the stone-free rate was calculated as 87%, 93% and 94%, respectively. Only five patients with lower renal caliceal stones were not stone free. The reported complications were macroscopic hematuria necessitating medical attention in four patients, skin ecchymosis in seven patients, severe colic pain in two patients, and urinary-tract infection in one patient. There was no need for hospitalization for these complications. Conclusion: SWL is effective and safe in patients with very small (≤5 mm) asymptomatic renal caliceal stones in all locations. © 2008 Mary Ann Liebert, Inc.