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WCE 2017: Shock Wave Lithotripsy for Large Renal Calculi: Is Prophylactic Stenting Beneficial?

Vancouver, Canada (UroToday.com) Dr. Tad Kroczak, clinical urological fellow of the St. Michaels Hospital in Toronto, presented his findings from a retrospective cohort study of shockwave lithotripsy (SWL) cases for fragmentation of large renal calculi (area ≥ 200 mm2). Due to the alleged risk of fragmented calculi obstructing the ureter (Steinstrasse) and leading to post-procedural complications, it is recommended that a ureteral stent be placed in the patient prior to receiving SWL therapy. Dr. Kroczak and his colleagues set out to determine whether the addition of a stent affects treatment success and complication rates.

168 solitary stone SWL cases were carried out at St. Michaels Hospital between January 2010 and April 2017. 84 patients were identified to have not used a stent, while the other 84 patients acted as a control group where a stent was placed before the procedure, then removed once the procedure was completed. The categories identified and deliberated within the study included complications at the 2-week mark, ER visits, Steinstrasse occurrence, UTI, post-operative stenting, and success rates. The resulting data was shown to have no significant statistical difference for any of the aforementioned categories between the stented and non-stented groups. 

Dr. Kroczak wanted to make the audience aware of the fact that 12% of the non-stented patients needed a stent placed postoperatively, but most of the patients studied did not require this treatment. He also brought attention to the Steinstrasse occurrence rates between the two groups, which was a rate of 14% in the non-stented cohort and 11% in the stented cohort. 

In conclusion, Dr. Kroczak explained how the data collected shows that preoperative stenting before SWL may not improve stone free rates and does not significantly improve postoperative complication rates. He later added that he would caution other urologists against routinely not stenting all patients with large renal calculi, regardless of the results of the study. 

Presented by: Tad Kroczak, MD 

Authors: Tad Kroczak, Daniela Ghiculete, R. John D’A. Honey, Michael Ordon, Jason Y. Lee, Kenneth T. Pace
Affiliation: St. Michaels Hospital - University of Toronto

Written by: Zachary Valley, Department of Urology, University of California-Irvine at the 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.