Risk Factors and Management of Steinstrasse after Shockwave Lithotripsy

INTRODUCTION: Shockwave lithotripsy (SWL) is a frequently used minimal invasive treatment for kidney and ureteral stones. Steinstrasse is one of the complications that can be managed either conservatively or surgically. The aim of this study is to assess the risk factors and management of steinstrasse after SWL, based on the findings of a systematic literature review.EVIDENCE ACQUISITION: Literature review was performed in MEDLINE/Pubmed, Scopus and Cochrane databases up to 01/2021. Data for steinstrasse and its management were extracted according to a prespecified extraction sheet. Analysis was performed using R statistical software.EVIDENCE SYNTHESIS: A total of 115 eligible randomized controlled trials (RCTs) were identified, analyzing data from 17827 patients. Overall, 725 (4.07%) patients experienced steinstrasse, with 368 (50.8%) managed conservatively and 232 (32%) surgically. 127 (17%) patients were treated with J-J stent and 32 (4.4%) with nephrostomy placement. Younger age, larger stone size, lower Kvs application, ramping-up protocol and use of electromagnetic lithotripters were more frequent in patients who formed steinstrasse, while those who needed surgical management were younger, with higher Hounsfield units (HU), were treated more frequently with electromagnetic lithotripters, lower Kvs and ramping-up protocol.CONCLUSIONS: Steinstrasse is a not uncommon complication after SWL and may necessitate surgical management in up to 35.2% of patients who experience it, thus appropriate counselling should be performed.