Clinical Experiences of Extracorporeal Shock Wave Lithotripsy Monotherapy in the Treatment of the Staghorn Calculi

Jang, Seok Chang; Chung, Jae Yong; Noh, Choong Hee

Abstract

We reviewed 26 patients with staghorn calculi to determine whether extracorporeal shock wave lithotripsy (ESWL) monotherapy with Dornier MPL-9000X lithotriptor is a successful alternative to the classical approaches. Of the staghorn calculi 5 cases were complete and 21 cases were incomplete staghorn. Double-J ureteral stents were placed in 24 of 26 patients before the ESWL. Of 15 patients with stone volume less than 20ml, 12(80%) showed stone-free after 5.7 mean session of ESWL. Of 11 patients with stone volume more than 20 ml, 7 (64%) became stone-free after 7.1 mean session of ESWL. The post-ESWL complications were flank pain in 9 patients (35%), gross hematuria in 24 (92%), high fever in 3 (13%) and steinstrasse in 24 (92%). Frank pain and high fever were managed successfully with analgesics and antibiotics. Gross hematuria disappeared spontaneously within 2 days. For the steinstrasse, the stone fragments passed spontaneously in 15 cases (62.5%) and ESWL to the steinstrasse was needed in other 9 cases (37.5%). Though the treatment of choice for the staghorn stones is combination therapy (PNL and ESWL) at the present, we experienced good results by ESWL monotherapy in staghorn calculi with Dornier MPL-9000X.