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.
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