An experimental study on residual lithiasis after shock wave lithotripsy

The main objective of this paper was to study residual lithiasis after extracorporeal shock wave lithotripsy (post-ESWL), with the aim of contributing to the development of effective prophylactic measures. In vivo regrown calcium oxalate monohydrate (COM) post-ESWL residual fragments were studied by stereoscopic microscopy, infrared spectroscopy and scanning electron microscopy with an energy dispersive X-ray analyzer. An in vitro system was also used to study the regrowth of post-ESWL fragments of COM calculi. The regrowth was evaluated as the relative increase in the weight of the fragments. The effects of a calcium oxalate crystallization inhibitor (phytate) were also evaluated. All of the in vivo regrown COM real residual post-ESWL fragments exhibited practically the same internal structural features. The in vitro studies demonstrated that the regrowth of post-ESWL residual fragments, in the absence of crystallization inhibitors, occurred even using normocalciuric/normooxaluric urine and could be detected at 24 h. At 144-240 h, the formation of new COM columnar zones was observed. The presence of 1.5 mg/l of phytate totally blocked the growth process. When hypercalciuric/normooxaluric urine was used, significant amounts of disorganized calcium oxalate dihydrate (COD) crystals were formed. The in vitro regrowth of post-ESWL COM fragments was clearly influenced by the presence of crystallization inhibitors. These data also demonstrate the importance that effective prophylactic therapies could exert on preventing recurrence.