Percutaneous Nephrolithotomy Followed by Extracorporeal Shock Wave Lithotripsy in the Treatment of Staghorn Calculi

In, Byong Ha; Kim, Joon Chul; Hwang, Tae Kon

Abstract

PURPOSE: The results of a combined approach of percutaneous nephrolithotomy (PNL) and shock wave lithotripsy (SWL) for the first treatment of staghorn calculi were analysed.
MATERIALS AND METHODS
The primary PNLs, followed by secondary SWL when necessary, were performed in 31 complete and 19 partial staghorn stones. All stone sizes ranged from 344 to 3,224mm2 (mean 1,166.6mm2). The success rate and many other factors, including the initial size and completion of the stone, an associated calyceal dilatation, the debulking rate of PNL, etc were analyzed. The data over the past 7.5 years was compared with the data from the previous 6 years.
RESULTS
The overall success rate was 88% (complete, 83.9%; partial, 94.7%), which was achieved by PNL alone in 19 cases and an additional SWL in 25 cases. Combination therapy showed the best results, when the area of the remnant stones was <=300mm2 or 20% of the initial stone after endoscopic debulking. Large stones, >=2,000mm2 in surface area, showed poor results in the combined treatment. Calyceal dilatation and ureteral stenting did not significantly affect the success rate. With time and experience, the success rate improved despite the decreased primary debulking rate, number of percutaneous procedures, and theater time, although this was no statistically significant.
CONCLUSIONS
Combined treatment is a good choice. It is efficient and minimally invasive for managing most standard patients with staghorn calculi, especially those <=2,000mm2 in surface area. The remnant stones, in locations difficult to access with PNL, could be safely pulverized with a consecutive SWL rather than a more aggressive PNL.