Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management

• Published in: BJU international Vol. 88; no. 7; pp. 675 - 678
• Main Authors: Sayed, M.A.‐B., El‐Taher, A.M., Aboul‐Ella, H.A., Shaker, S.E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.11.2001; Blackwell
• Subjects: Adult; Aged; Biological and medical sciences; Diseases of the urinary system; Endoscopy; ESWL; Female; Humans; Kidney Calculi - etiology; Kidney Calculi - prevention & control; Kidney Calculi - therapy; Lithotripsy - methods; Male; Medical sciences; Middle Aged; nephrostomy; Nephrostomy, Percutaneous - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); renal stones; Risk Factors; steinstrasse; Ureteral Calculi - etiology; Ureteral Calculi - prevention & control; Ureteral Calculi - therapy; Ureteral Obstruction - etiology; Ureteral Obstruction - prevention & control; Ureteral Obstruction - therapy; ureteroscopy; Ureteroscopy - methods; Kidney disease; Human; Nephrostomy; Urinary system disease; Instrumentation therapy; Ureteral disease; Urinary tract disease; Obstruction; Kidney; Urinary stone; Treatment; Surgery; Lithotripsy; Lithiasis; Complication; Endoscopy; Ureter
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1046/j.1464-4096.2001.02435.x

Objective To determine the causes of steinstrasse, methods of prevention and treatment strategies. Patients and methods Fifty‐two patients with steinstrasse were identified and treated; all patients were initially treated conservatively but when there was obstruction, infection or no progression of the stone fragments, further treatment was used, ranging from repeated extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrostomy (PCN), endoscopic manipulations and finally open surgery, depending on the degree of obstruction, infection, renal function and response to each kind of therapy. Results Conservative management was successful in 25 patients (48%), repeated ESWL in 12 (23%), PCN in 10 (19%), ureteroscopy in three (6%) and open surgery in two (4%). Conclusion As many patients, and particularly those with larger stones, are treated by ESWL, the risk of developing steinstrasse will increase, with associated patient discomfort, infection or impaired renal function. The optimum selection of cases (aiming to pulverize the stones rather than fragment them) and accurate stone targeting are essential to minimise the development of steinstrasse. The meticulous follow‐up of patients with steinstrasse should prevent any loss of renal function. When there is obstruction and/or infection or renal damage, active treatment is indicated, of which ESWL and PCN are the most effective, with ureteroscopy and open surgery reserved for difficult cases.