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Stone Management
Facilitated passage of fragments from the ureter may be Considering the asymptomatic residual fragments, the risk of
accomplished by administration of alpha-adrenoreceptor developing new stones is – with the exception of infected stone
antagonists or calcium-channel-blocking agents. Administration of material – relatively low, and during a four-year period only a minor
these agents has also resulted in better clearance of stone fraction of patients developed new stones that required a new
material from the kidney.
1,2,48,75–79
Although some studies have active stone-removing procedure. Although patients with residual
shown improved elimination of fragments from the kidney fragments/stones might benefit from a surveillance programme, this
following administration of potassium citrate and sodium is also true for a large group of patients without stones or fragments
potassium citrate, such an effect has not been observed by others. because of the character/severity of their stone disease. It should
From a theoretical point of view, administration of furosemide and be noted that over a four-year period the average risk of forming a
potassium citrate for a period after satisfactory disintegration new calcium stone is around 40–45%.
appears attractive. Clearance of stone material from the kidney
after ESWL is an interesting field that deserves appropriate These drawbacks are a minor price to pay for the advantages that
attention in the future. ESWL offers: an anaesthesia-free outpatient procedure that in the
vast majority of cases can be carried out non-invasively with a low
Conclusions risk of complications. n
The main reasons for selecting a more invasive endoscopic
procedure than ESWL for active stone removal is to avoid both the
Hans-Göran Tiselius is a Professor of Urology in the Renal
need for repeated treatment sessions and any problems that might
Stone Unit in the Department of Urology at the Karolinska
be associated with residual fragments in the kidney. However, from University Hospital, and at the Division of Urology in the
the data reported above it should be obvious that even when used
Department of Clinical Science, Intervention and
Technology at the Karolinska Institute. He founded the
in an unselected group of patients with urinary stones, the fraction
first extracorporeal shock-wave lithotripsy (ESWL) unit in
of patients requiring more than one treatment session is less Linköping in 1985, and has subsequently focused on the
than 30%: 28% for renal stones and 23–24% for ureteral stones.
treatment of patients with stone disease from a surgical
and medical point of view. His research efforts have been
Re-treatments are usually necessary for stones that are either large
directed at both a better understanding of the mechanisms of stone formation and stone
or impacted. The bottom line is that more than 95% of the stones removal with as few invasive procedures as possible. Over the past 24 years, Dr Tiselius
encountered can be sufficiently disintegrated with ESWL, leaving
has had direct or indirect experience of more than 20,000 ESWL treatments.
the patient without symptoms.
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