The complications after extracorporeal shock wave lithotripsy (ESWL) for large renal calculi could be reduced by insertion of ureteral stents. In a prospective study, the critical stone size for ESWL combined with ureteral stenting was looked for. Sixty consecutive patients entered the study, 17 patients suffered from renal calculi with a length of > 4 cm and a width of > 3 cm (group 1 ), and in 43 patients the calculi measured between 4 X 3 and 2.5 X 1.5 cm^2 (group 2). ESWL was performed with the Dornier apparatus HM-3. A ureteral stent was placed immediately before ESWL. In group 1 with very large stones, significantly more obstructive problems were encountered. Three months after ESWL, only 6 of 14 (43 %) were free of stones or with stone material likely to discharge spontaneously. In group 2, a success rate of 25 of 29 (86%) was noticed, which was considered satisfactory. For most stones >4 X 3 cm^2 the combination of percutaneous nephrolithotomy and ESWL seems to be the preferred treatment.

Keywords:
Extracorporeal shock wave lithotripsy, complications and success rate, Ureteral stents, Large renal stones
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1988
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