Critical Evaluation of Treatment of Staghorn Calculi by Percutaneous Nephrolithotomy and Extracorporeal Shock Wave Lithotripsy

Abstract

The combined use of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy in patients with staghorn calculi has become an established treatment regimen. We evaluated the results of 90 staghorn calculi-bearing kidneys treated with such combination therapy after a mean follow-up of approximately 2 years. A total of 69 kidneys (76.7 per cent) became free of stones at some point after treatment. However, due to stone recurrence this number decreased to 55 kidneys (61.1 per cent) at the end of follow-up. Patients who had undergone a previous open operation on the stone-bearing kidney showed less favorable results than the over-all group. When our results were compared to reported data on open surgery or percutaneous nephrolithotomy alone even better results may have been obtained by such treatment modalities. However, our data indicate that percutaneous stone debulking combined with further destruction of residual stone fragments by shock wave lithotripsy certainly is less invasive than an open operation and provides an alternative to percutaneous treatment alone, which can yield comparable results.

Pathophysiology and Management of Infectious Staghorn Calculi

“…Though well popularized in the 1990s, combination therapy is less commonly used today due to its inferior results compared with PCNL monotherapy. For example, Schulze and colleagues [47] found that 76.7% patients were stone-free after combination therapy and this decreased to 61.1% at the end of follow-up due to recurrence. In a larger series of 343 cases of staghorn calculi by Lam and colleagues [48], PCNL alone achieved a stone-free rate of 91% compared with 78.1% to 79.1% with the combination approach.…”

Retroperitoneal laparoscopic pyelolithotomy: how does it compare with percutaneous nephrolithotomy for larger stones?

“…Extracorporeal shock wave lithotripsy (ESWL) is usually the treatment of choice for renal calculi £ 3 cm in size and percutaneous lithotripsy (PCNL) for larger stones [9][10][11][12][13][14][15][16]. However, in view of a recent report by Wilson et al showing pyelotomy as the safest available modality for treatment of renal lithiasis today, if pyelolithotomy could be performed by a minimally invasive technique, it might become the treatment of choice for such patients [17][18][19].…”

Surgical Challenge of Massive Bilateral Staghorn Renal Calculi in a Spinal Cord Injury Patient

“…Furthermore, Lechevallier et al [13] reported a higher likelihood for renal scar formation after ESWL sessions than after percutaneous nephrolithotomy [13]. Therefore, treatment options were directed towards a percutaneous surgical approach [14][15][16][17], open surgical approach [18], or various combinations of multi-modality treatments [8,19,20]. The decision to perform percutaneous nephrolithotomy in our patient rather than open surgery was influenced by a variety of factors.…”