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Background and Purpose To assess the results of shockwave lithotripsy (SWL) for renal calculi in upper, middle, and lower calices according to the stone burden.Patient and Methods A series of 52 female and 66 male patients with a mean age of 47.8 years and isolated single caliceal stones who underwent SWL monotherapy were enrolled. Stone burden, stone location, number of sessionsshockwaves, and auxiliary procedures were noted for each patient. Stones were located in the upper, middle, and lower calices of 35, 43, and 40, patients respectively, with mean stone burdens of 81.4 mm2, 75.2 mm2, and 96.3 mm2, respectively. Patients were evaluated with intravenous urography, plain film, or ultrasonography. Success was determined 3 months after the last session. Re-treatment rates were calculated. The effect of anatomic factors on the success of treatment for lower-caliceal stones also was determined.Results The mean stone burden, median number of treatment sessions, and mean number of shockwaves were 84.2 mm2, 2, and 4344, respectively. The auxiliary procedure rate was 16.1, and the re-treatment rate was 71.2. Failure was noted in 26 patients (22). The stone-free rates for stones in the upper, middle, and lower calices were 82.8, 83.4, and 67.5, respectively (P 0.14). The stone-free rates for stones <100 mm2and 100 to 200 mm2were 91.2 and 65.5, respectively (P 0.001). The efficiency quotient was 49.8, 44.8, and 32.5 for upper-, middle-, and lower-caliceal stones, respectively. Infundibular length (P 0.006) and infundibular width (P 0.036) were significant in determining the stone-free rate after treatment of lower-caliceal stones.Conclusions We recommend SWL as the first choice for treatment of stones <200 mm2in the upper and middle calices. Extracorporeal lithotripsy is one of the options for lower-caliceal stones <200 mm2but has high re-treatment and auxiliary-procedure rates in these cases. [ABSTRACT FROM AUTHOR]

Background and Purpose Studies reporting the outcome of percutaneous nephrolithotomy (PCNL) in relation to stone burden and configuration are limited. We analyzed our stone-free and complication rates of PCNL with regard to stone surface area and configuration.Patients and Methods Data of 234 patients who underwent PCNL were analyzed retrospectively. Patients were stratified into six groups according to stone burden and into four groups in relation to stone configuration. Groups were compared with respect to the number of tracts, success of therapy, complications, requirement for secondary procedures, drop in hematocrit, and blood transfusion requirement.Results The overall stone-free rate was 78.6 with a complication rate of 34.6. Stone-free rates decreased with increasing stone size (P 0.001) and with increasing caliceal component in complex stones (P 0.01). The total number of complications rose with increasing stone surface area (P 0.0001); however, stone distribution within the kidney did not affect the complication rate (P 0.2). The mean operative time rose with increasing stone burden (P< 0.05) and increasing caliceal involvement by complex stones (P< 0.01). The need for multiple tracts also rose with increasing stone burden (P< 0.05).Conclusion There is a decrease in the overall stone-free rate, as well as an increase in the complication rate, the secondary procedure rate, the mean operative time, and the need for multiple tracts, with increasing stone surface area with PCNL. With regard to stone configuration, there is a decrease in the stone-free rate, as well as an increase in the operative time, with increasing caliceal component in complex renal stones. [ABSTRACT FROM AUTHOR]