The Further Treatment Tactics Choice of Patients after Extracorporeal Shock-Wave Lithotripsy

Extracorporeal shock-wave lithotripsy (ESWL) has been widely used for the last decades and has proved to be a worthy alternative to endoscopic and percutaneous techniques for stones up to 2 cm in size. The results of ESWL as well as possible complications depend on the tactics of postoperative treatment of patients. The purpose of the research was to examine the factors determining the further treatment tactics choice of patients after ESWL. Materials and methods. The ESWL were used in 127 patients (women - 68, men - 59) with urolithiasis. The sizes of kidney stones varied from 6 to 20 mm, the size of the stones of the ureters was 5 to 17 mm. The ESWL sessions were performed on the Dornier Compact Sigma lithotripter (Germany), under ultrasonic control. Tactics of postoperative patients' treatment (outpatient or in hospital) was determined by the localization of the stone, its sizes, severity of the pain syndrome, as well as the presence of exacerbation chronic pyelonephritis episodes in the anamnesis. 27 (17,3%) of patients with renal localization of stones, stone diameter of more than 1.5 cm, pain syndrome, requiring more than 3 doses analgesics per day, as well as the presence of an episode of exacerbation of chronic pyelonephritis during last two weeks before ESWL were hospitalized. In 105 (82.6%) patients the lithotripsy was carried out on outpatient basis. Results. The majority of patients (92.4%) who were on outpatient treatment noted a decrease in incidence and the severity of painful attacks after ESWL. Hospitalization within 5 days after ESWL was required, in 8 (7.6%) patients. In 5 (4.7%) cases it was associated with repetitive attacks of renal colic, in 3 (2.8%) cases with exacerbation of chronic pyelonephritis. The incidence of attacks of renal colic was observed in 6 (27.2%) patients treated in the hospital. Exacerbation of chronic pyelonephritis occurred in 2 (9%) of hospitalized patients. The above complications in the postoperative period were observed in patients with kidney localization of the stone. The ultrasound investigation was performed in 5 days after ESWL. The absence of stones in the kidneys and urinary tracts was noted in 76 (72.3%) patients of the outpatient group and in 14 (63.3%) patients treated in the hospital. The repeated session of ESWL was performed in patients with residual fragments of stone more than 4 mm. Conclusions. Factors determining the treatment tactics after ESWL are the localization of the stone, its sizes, severity of the pain syndrome, and presence of exacerbation of pyelonephritis episodes in the anamnesis. Outpatient patients' treatment can be considered as a first choice. Hospital treatment is recommended in patients with kidney stone larger than 1.5 cm, severe pain syndrome, requiring more than 3 doses of analgesics per day, and an episode of exacerbation of chronic pyelonephritis within 2 weeks before ESWL.