Clinical Implications of Clinically Insignificant Stone Fragments After Extracorporeal Shock Wave Lithotripsy

No AccessJournal of UrologyClinical Urology: Original Article1 Apr 1996Clinical Implications of Clinically Insignificant Stone Fragments After Extracorporeal Shock Wave Lithotripsy Steven B. Streem, Agnes Yost, and Edward Mascha Steven B. StreemSteven B. Streem More articles by this author , Agnes YostAgnes Yost More articles by this author , and Edward MaschaEdward Mascha More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66208-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined the natural history and clinical significance of small, asymptomatic, noninfection related stone fragments after extracorporeal shock wave lithotripsy (ESWL*). Materials and Methods: We prospectively followed 160 patients with 4 mm. or less asymptomatic calcium oxalate/phosphate stone fragments after ESWL for 1.6 to 88.8 months (mean 23) to stone-free status, censorship or intervention. Kaplan-Meier estimates of probability to anatomical stone-free, decreased or stable status were determined as well as the probability of symptomatic episodes or required urological intervention. Results: Stone-free status or a decreased, stable or increased amount of residual stone occurred in 38 (23.8 percent), 26 (16.3 percent), 67 (41.9 percent) and 29 (18.1 percent) of the 160 patients, respectively. At 5 years after ESWL the probability of a stone-free, stone-free or decreased status, or stone-free, decreased or stable status was 0.36, 0.53, and 0.80, respectively. A total of 91 patients (56.9 percent) remained asymptomatic while 69 (43.1 percent) had a symptomatic episode or required intervention 1.6 to 85.4 months (mean 26) after ESWL (probability estimated at 0.71 at 5 years). Conclusions: While patients with small noninfection related stone fragments after ESWL may be followed expectantly, a significant number will require intervention or have symptomatic episodes within 2 years. The term clinically insignificant applied to any residual stone after ESWL is likely a misnomer. References 1 : Extracorporeal shock wave lithotripsy: the Methodist Hospital of Indiana experience. J. Urol.1986; 135: 1134. Link, Google Scholar 2 : Does further extracorporeal lithotripsy promote clearance of small residual fragments? Brit. J. Urol.1991; 68: 565. Google Scholar 3 : Lithostar extracorporeal shock wave lithotripsy: the first 1,000 patients. J. Urol.1992; 147: 1006. 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Volume 155Issue 4April 1996Page: 1186-1190 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.MetricsAuthor Information Steven B. Streem More articles by this author Agnes Yost More articles by this author Edward Mascha More articles by this author Expand All Advertisement PDF downloadLoading ...