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      Lower-pole caliceal stone clearance after shockwave lithotripsy, percutaneous nephrolithotomy, and flexible ureteroscopy: impact of radiographic spatial anatomy.

      Journal of endourology / Endourological Society

      Ureteroscopy, Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Kidney Calculi, radiography, therapy, Kidney Calices, Lithotripsy, adverse effects, Male, Medical Illustration, Middle Aged, Nephrostomy, Percutaneous, Retreatment, Treatment Outcome

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          Abstract

          Spatial anatomy of the lower renal pole, as defined by the infundibulopelvic angle (LIP angle), infundibular length (IL), and infundibular width (IW), plays a significant role in the stone-free rate after shockwave lithotripsy. A wide LIP angle, a short IL, and a broad IW, individually or in combination, favor stone clearance, whereas a LIP <70 degrees, an IL >3 cm, or an IW < or =5 mm are individually unfavorable. When all three unfavorable factors or an unfavorable LIP and IL coexist, the post-SWL stone-free rate falls to 50% or less. Using these criteria, more than one fourth of our patients with a lower-pole calculus might have been better served by an initial percutaneous or perhaps ureteroscopic procedure, neither of which is significantly affected by the lower-pole spatial anatomy.

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          9607435

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