Presented by: Emma Stehr BMBS
The Prince Charles Hospital, Queensland Health

Introduction

Management of stones >20mm can often be a complex conversation with patients. Both the American Urology Association (AUA) and the European Association of Urology recommend consideration of a percutaneous approach in larger stones ≥20mm. Despite this, patient preferences and comorbidities are often at odds with this ideal. In a Queensland public-sector high-volume stone unit, after discussion with patients, often a tailored approach is formulated.

The object of this study was to review the rates of endoscopic requirement for completion in management of stones >20mm initially managed with extracorporeal shock wave lithotripsy (ESWL) and an index stent insertion. In a tertiary stone centre, with Queensland’s only public full-time lithotripter, multimodal therapy can be offered. 

Materials

This study retrospectively analysed data from all planned elective procedures for renal stones  ≥20mm who underwent index stent insertion with ESWL for management at a single site high-volume public stone unit from 1^st January 2017-31^st December 2022.  All ESWL treatments were administered under the guidance of a consultant urologist with delivered shocks dependent on intra-operative fragmentation assessment. All stones included in this study were radio-opaque in nature. Incomplete clearance was considered if fragments remaining were ≥3mm.

Results

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43 patients met inclusion criteria.  ESWL management was utilised by 25 patients without endoscopic management (including basketing or laser lithotripsy). 16.67% of patients required endoscopic management with 3 or more procedures after ESWL.

Conclusion

ESWL treatment can be considered in close discussion with the patient however this small cohort highlights that patients should be counselled on the risk of multimodal and repeated treatments for stone clearance.

Funding

None

Co-Authors

Akshay Kothari,
The Prince Charles Hospital, Queensland Health