Combined Treatment of Staghorn Calculi by Percutaneous Nephrolithotomy and Extracorporeal Shock Wave Lithotripsy.
- Author:
In Gi SEOUNG
1
;
Seung Chul YANG
;
Moo Sang LEE
Author Information
1. Department of Urology, Yonsei University, College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
staghorn calculi;
PNL;
ESWL
- MeSH:
Calculi*;
Cohort Studies;
Follow-Up Studies;
Humans;
Length of Stay;
Lithotripsy*;
Nephrostomy, Percutaneous*;
Retrospective Studies;
Shock*;
Stents;
Ureter;
Urinary Tract;
Urinary Tract Infections
- From:Korean Journal of Urology
1988;29(6):917-923
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
On the 59 cases of staghorn calculi treated at our institution with either ESWL monotherapy or initial percutaneous nephrolithotomy followed by ESWL between July 1987 and June 1988, 50 cases(22 complete and 28 partial staghorns) have adequate follow up. Using a retrospective cohort design, patients were matched for age, sex, stone size, stone complexity, renal function, urinary tract infection and urinary tract obstruction. Twenty five pairs of combination therapy and ESWL monotherapy patients with complete data were matched. The groups were not significantly different in the matching parameters. A significantly higher stone free rate follows combination therapy versus ESWL monotherapy for complete staghorns(25% vs. 0% in the case of 1 time ESWL treatment : 76% vs. 40% at 3 months follow up visit but the difference is slight for partial staghorns(54% vs. 47% in the case of 1 time ESWL treatment ; 85% vs. 73% at 3 months follow up visit). Both have similar length of hospital stay for complete staghorns(15 days vs. 14 days), but a significantly longer hospital stay follows combination therapy for partial staghorns(13 days vs. 6 days). The morbidity of the combination approach is not greater than that of ESWL monotherapy(40% vs. 36%), where as the need for axillary procedures is significantly lower in this group(16% vs. 36%). Our results indicate that virtually all staghorn calculi are best treated with initial percutaneous nephrolithotomy followed by ESWL. This approach allows for chemolysis and secondary procedures. But small volume partial staghorns in nondilated systems may be considered for ESWL monotherapy with ureteral stenting.
