Efficacy of extracorporeal shock wave lithotripsy monotherapy in complex urolithiasis in the era of advanced endourologic procedures.

PURPOSE It is believed that extracorporeal shock wave lithotripsy (ESWL) may be less effective than other modalities for treating stones in complex calculi. In this study, we investigated the efficacy of ESWL for treatment of complex stones. MATERIALS AND METHODS Between September 2002 and October 2003, 250 complex cases of urolithiasis, including ureteral stones, staghorn stones, and stones in children, high risk patients, single kidneys, steinstrasse, and horseshoe kidneys were selected to be treated with Siemens Lithostar (Siemens AG, Munich, Germany) on an outpatient basis. Data were collected prospectively and the results of ESWL monotherapy on these complex patients were reviewed. RESULTS The overall success rate was 91.2% for children and 77.7% for patients with single kidneys. Also, ESWL was efficient in the treatment of ureteral stones at the rate of 70.5% to 83.3%, depending on the location of the stone in the ureter and its size. The success rate of ESWL for patients with horseshoe kidneys, staghorn stones, and steinstrasse were marginal (66.6%, 66.0% and 33.3%, respectively). All of the cases were managed on outpatient basis and hospital admission was not required. CONCLUSION Outpatient ESWL can be safely performed as a minimally invasive treatment after proper patient selection, even for complex patients. Its successfulness in children, patients with solitary kidney, and for almost all of ureteral stones is quite acceptable. However, its usage in patients with horseshoe kidneys or steinstrasse, and those with staghorn stones is questionable and should be done only in carefully selected cases. Thus, with appropriate patient selection, significant improvements in stone-free rates may also be achieved in these cases.