Introduction & Objectives: We determined whether there is a significant relationship between the radiographic renal anatomic features on preoperative excretory urography (IVP) and stone fragments clearance after ESWL.
Material & Methods: Total of 282 patients with mean age 45.8+ 13.2 years (189male, 93female), who underwent ESWL due to renal calculi between October 2005 and Augusts 2009 were enrolled. The mean calculi load was 155.72 + 127.66mm². The patients were stratified into three groups; patients with pelvis calculi(group 1), patients with upper or middle pole calculi(group2) and patients with lower pole calculi(group 3). Three angles on the pretreatment IVP were measured; the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle I), inner angle between lower pole infundibular axis and main axis of pelvis-UP junction point (angle II) and inner angle between lower pole infundibular axis and perpendicular line (angle III). Multivariate analysis were used to define the significant predictors of stone clearance.
Results: The over all success rate was 85.81%. All angles, sessions number,  shock waves number and stone burden were significant predictors of success in patients in group 1. However in group 2 only angle II and in group 3, angle I and angle II, had significant effect on stone clearance.
Conclusions: Radiographic anatomic features have significant role in determining the stone –free rate following satisfactory fragmentation of renal stone with ESWL. Angle II defines the relation of renal pelvis with lower pole and UP junction point and it had significant influence on stone clearance in all groups. Angle III is of low significant influence for patients with renal pelvis stone, however in patients with lower, upper or middle pole it had not impact on the stone clearance. This mean that the perpendicularity or the gravity effect of the lower pole is not the only mechanism which standing behind the retention of the fragments after lithotripsy. Therfore the measurement of infundibulopelvic angle in different manner help to predict the stone-free status in patients with renal calculi located not only in lower pole but also in renal pelvis and upper or middle pole. The gravity effect seems to be not enough to justify the significant influence of the radiographic anatomic features on the stone clearance and on the retention of the fragments in the lower pole.

Title

European Urology Supplements

Publisher

Elsevier

Publisher Country

Netherlands

Indexing

Thomson Reuters

Impact Factor

3.462

Publication Type

Both (Printed and Online)

Volume

9

Year

2010

Pages

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