Use of double-J in extracorporeal shock wave lithotripsy of large renal calculi

Treatment of large renal calculi by extracorporeal shock wave lithotripsy alone has not been accepted yet as the treatment of choice because of the high incidence of complications such as stone street inducing obstructive uropathy. From Sep. 1987 to Nov. 1987, Thirty four patients had received double-J catheter in ureter before E.S.W.L. to prevent ureteral obstruction. The age distribution was from 29 to 66 years old (mean = 49.1 Y/O) and male to female ratio was 3:1. All the stone size was larger than 20mm in its longest axial length. Each patient was followed at least 3 months, and the results indicated that 8 patients (23.53%) had stone free, 11 patients (32.35%) had sandy stone in kidney, and 15 patients (44.12%) had stone street in ureter. The additional treatments for significant residual stone included 3 patients needing ureteroscopy, 8 patients needing more than one session of E.S.W.L. and 4 patients having spontaneous stone passage after removal of double-J. Although the necessity of external diversion and the incidence of colic pain after E.S.W.L. would reduce so as to improve patients' quality of life, double-J does not increase the stone free rate, and ureteral obstruction was still possible to induce the renal function impairment. We suggest that double-J be removed as soon as possible if the stone fragments have no change in position after 2-4 weeks of followup and adjuvant treatment be necessary.