Is extracorporeal shock wave lithotripsy still the treatment of choice for renal and upper ureteric calculi: Our experience with 274 cases and its comparison with retrograde intrarenal surgery literature
Background: Extracorporeal shock wave lithotripsy (ESWL) is used in the management of renal calculi <2cm in size using shock waves under ultrasound/X-ray guidance. Nowadays, with the advancement of endourology the use of ESWL has become less. Newer techniques such as retrograde intrarenal surgery and percutaneous nephrolithotomy have replaced ESWL for treatment of renal stones. Materials and Methods: A total of 274 patients between age group of 15 months and 78 years from Department of Urology, MGM Medical College were enrolled in the study for 3 years from October 2015 to October 2018. All patients underwent intravenous pyelogram. The inclusion criteria of the study were patients with calculi between 6 and 20mm. The exclusion criteria of the study were patients having untreated urinary tract infection, pregnancy, musculoskeletal deformity, and deranged coagulation profile. Double J stenting was performed prior to the procedure for stones >1cm. A maximum of three sessions of ESWL were given. The procedure was performed under local anesthesia for adults and under general anesthesia for children. Results: There was no effect of age and sex on stone clearance. Overall success rate was 91.97%. Success rate for smaller calculi was more (6–10 mm: 97.7%; 10–15 mm: 90.1%; 15–20 mm: 87.5%) with P value <0.05. Success rate of calculi in lower calyx (83.63%) were less as compared to calculi in upper calyx (96.77%), middle calyx (96.15%), renal pelvis (90%), and upper ureter (88.23%) with P value <0.05. Complications of the procedure included pain (28 patients required no treatment and 3 patients required admission and treatment) and hematuria (15 patients required no treatment and 2 patients required admission and treatment), and 1 patient with perinephric hematoma who was treated conservatively. Conclusion: ESWL is a safe and effective procedure in treatment of renal and upper ureteric calculi. It can still be regarded as treatment of choice for appropriate cases of renal and upper ureteric stones especially in developing countries where cost is still a major factor.