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One Year's Experience at a Single Center

Robert A. Riehle, Jr, MD; William R. Fair, MD; E. Darracott Vaughan, Jr, MD

JAMA. 1986;255(15):2043-2048.

Abstract
Four hundred sixty-seven patients with symptomatic upper urinary tract calculi underwent extracorporeal shock-wave lithotripsy (ESWL) at The New York Hospital-Cornell Medical Center during the first year. Ninety-five percent of stones were completely treated with one ESWL session. An analysis of 300 treatments revealed that the overall stone-free rate (success) three months after treatment was 75% The stone-free rate for patients with renal pelvic calculi less than or equal to 20 mm in diameter was 91%. Individual patient stone-free rates depended on stone size (burden), position, composition, and quality of disintegration. Two percent of treatments failed to disintegrate the targeted stone. Complications were minimal. Seven percent of treatments were followed by a secondary endoscopic procedure to facilitate complete stone passage, and 23% of treatments were preceded by cystoscopy with ureteral stent placement or manipulation of stones. Combined therapy utilizing percutaneous surgery or multiple sequential ESWL treatments is necessary for complex stones, and ureteroscopy or basket extraction remains the treatment of choice for distal ureteral calculi.

(JAMA 1986;255:2043-2048)

Author Affiliations
From The James Buchanan Brady Foundation and the Division of Urology, Department of Surgery, The New York Hospital-Cornell Medical Center (Drs Riehle and Vaughan); and the Urologic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York (Dr Fair).

Footnotes
Reprint requests to the Division of Urology, The New York Hospital—Cornell Medical Center, 525 E 68th St, Room F-957, New York, NY 10021 (Dr Riehle).

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