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Journal of Zhejiang University SCIENCE A 2000 Vol.1 No.3 P.347-351

http://doi.org/10.1631/jzus.2000.0347


RADIOGRAPHIC ANATOMICAL INSIGHTS INTO MECHANISM OF LOWER CALYCEAL STONE EVACUATION FOLLOWING ESWL


Author(s):  XIE Li-ping, SHI Shi-fang

Affiliation(s):  Dept.of Urology, First Affiliated Hospital, Medical College,Zhejiang University, Hangzhou 310003, China

Corresponding email(s): 

Key Words:  extracorporeal shock wave lithotripsy, kidney, lower calyx, renal calculi


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XIE Li-ping, SHI Shi-fang. RADIOGRAPHIC ANATOMICAL INSIGHTS INTO MECHANISM OF LOWER CALYCEAL STONE EVACUATION FOLLOWING ESWL[J]. Journal of Zhejiang University Science A, 2000, 1(3): 347-351.

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Abstract: 
This study was aimed to elucidate whether there is significant relationship between the lower calyceal anatomy and stone evacuation following extracorporeal shock wave lithotripsy(ESWL). From April 1995 to November 1999,145 patients with lower caliceal stones underwent ESWL with Storz Modulith SL20 lithotriptor. The pelvicalyecal angle, lower pole infundibular length and width, and lower pole calyceal pattern of the stone-bearing calyx were measured on pre-ESWL intravenous urograms. Abdominal plain film and ultrasonography taken of all patients at the 3-month followup showed that the overall stone-free rate was 65% after 3 months. The stone-free rate was significantly correlated to the radiographic anatomical factor, 94% in patients with a pelvicalyceal angle of 90 degrees or greater, 57% in those with less than 90 degrees pelvicalyceal angle; 80% in those with infundibular length of 30 mm or less, 59% in those with infundibular length greater than 30 mm; 73% in those with infundibular width greater than 4 mm, 48% in those with infundibular width of 4 mm or less; 85% in those with a simple calyceal pattern and 41% in those with a complex one. These findings suggest that the 4 radiographic anatomical factors of the lower pole calyx(pelvicalyceal angle, infundibular length and width and calyceal pattern) play an important role in stone evacuation after ESWL. Pelvicalyceal angle of 90 degrees or greater, infundibular length of 30 mm or less and width greater than 4 mm, and simple calyceal pattern are respectively noted to relate to an improved stone-free status. In contrast, an acute pelvicalyceal angle, long infundibular length and narrow infundibular width and complex calyceal pattern are individually unfavorable factors for stone emptying following ESWL.

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Reference

[1]Elbahnasy, A.M., Shalhav,A.L.,Hoenig,D.M. et al.,1998. Lower calyceal stone clearance after shock wave lithotripsy or ureteroscopy:the impact of lower pole radiographic anatomy. J Urol,159:676-682.

[2]Graff,J., Diederichs, W., Schulze, H., 1988. Long-term follow up in 1003 extracorporeal shock wave lithotripsy patients. J Urol, 140:479-483.

[3]Sabnis, R.B., Naik, K.,Patel, S.H. et al.,1997. Extracorporeal shock wave lithotripsy for lower calyceal stones:can clearance be predicted. Br J Urol, 80:853-857.

[4]Sampaio, F.J.B., Aragao, A.H.M., 1992. Inferior pole collecting system anatomy:its probable role in extracorporeal shock wave lithotripsy. J Urol, 147:322-324.

[5]Sampaio, F.J.B., Aragao, A.H.M., 1994. Limitations of extracorporeal shock wave lithotripsy for lower calyceal stones:anatomic insight. J Endourol, 8:241-247.

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