Outcome of Extracorporeal Shock Wave Lithotripsy in Patients with Multiple Renal Calculi Based on Stone Burden and Location

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Abstract
Of 2234 renal units treated with the Dornier HM3 lithotriptor, 641 contained multiple renal calculi. The treatment:kidney ratio ranged from 1.0 to 1.58 (mean = 1.47) and was dependent on stone burden and location. Radiologic follow-up on 525 renal units after 3 to 42 months (mean = 7.5 months) showed 54.1% were stone free, 21.5% had residual sand or matchheads (≤4 mm), and 24.4% had residual fragments >4 mm. A significant difference in stone-free efficacy was demonstrated between stones ≤15 mm and >15 mm (p < 0.001) and <30 mm and ≥30 mm (p < 0.001). Patients with multiple renal calculi ≤l5 mm became stone free in 72% of cases compared with 40% of those with a stone burden ≥30 mm. Stone-free efficacy was also influenced by stone site but did not reach statistical significance. Complications occurred in 49 renal units (9.3%) and were unrelated to stone burden. New stone formation occurred in 18 cases (3.4%). The presence of multiple renal calculi has an adverse effect on stone-free outcome.