Outcome of shock wave lithotripsy as monotherapy for large solitary renal stones (>2 cm in size) without stenting

PURPOSE: To evaluate the outcome of shock wave lithotripsy (SWL) as monotherapy for solitary renal stones larger than 2 cm without ureteral stenting. MATERIALS AND METHODS: Our retrospective study included patients with solitary renal radio opaque stones larger than 2 cm treated with SWL using electromagnetic Dornier Compact S lithotripter device (Wessling, Germany) for a period of 3 years (September 2002-2005). Stone clearance was assessed at 1 week, 1 month, and 3 months with plain X-rays of kidney, ureter, and bladder region, ultrasonography, and tomograms. Stone-free status, morbidity of the procedure, and fate of clinically insignificant residual fragments (CIRF) were studied. A stone-free state was defined as no radiologic evidence of stone. Success was defined as complete clearance + CIRF. RESULTS: Fifty-five patients, aged 11–65 years (mean 49.8) underwent SWL. Of them, only two were children. Male-to-female ratio was 3:1. The stone size was 21–28 mm (average 24 mm). The mean number of shocks were 3732 (range 724–12,100) and average energy level was 14 kV (range 11–16 kV). The mean follow-up was 18 months (range 3–22 months). Over all, stone-free status was achieved in 50% and success in 81% at 3 months. Stone clearance was not affected by stone location. Stones <25 mm had better stone-free rate (54.16% vs. 28.5%) and lesser CIRF (14.6% vs. 28.5%) when compared to larger stones (>26 mm) (P = –0.10). Of 54 patients, 39 developed steinstrasse with mean length of 3.2 cm (range 1.4–6.2 cm) and only four required intervention. Effectiveness quotient (EQ) for SWL monotherapy for solitary renal stones more than 2 cm was 25.3%. The EQ for stones <25 mm and those more than 25 mm were 28.4% and 10% (P = –0.12), respectively. There was a lesser trend of difference between stones with size <25 and more than 25 mm. During the last review, the overall stone-free rate was 67.2%. CONCLUSIONS: SWL monotherapy was safe but significantly less effective for solitary renal stones larger than 2 cm. It can only be suggested to those who refuse surgical intervention. Pretreatment DJ stenting is not mandatory when closer follow-up is ensured.