IS PERCUTANEOUS MONOTHERAPY FOR STAGHORN CALCULUS STILL INDICATED IN THE ERA OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY

Staghorn stones can be treated by percutaneous nephrolithotomy (PCNL) or by extracorporeal shockwave lithotripsy (SWL); however, the combina tion of the two techniques appears as the most frequent treatment. In a previous study, the investigators noted that staghorn calculi treate d with PCNL monotherapy have a good clearance rate. Herein, we have re viewed 102 staghorn stones that underwent PCNL before (1984-1986) (Gro up 1; n = 51) and after (1987-1990) (Group 2; n = 45) the introduction of SWL. The stone burden has increased in both size and complexity: t here were 27 complete staghorn calculi (60%) in Group 2 compared with 19 (37%) in Group 1. Despite the higher number of kidney punctures, bl ood urea nitrogen and serum creatinine measurements demonstrated impro vement of renal function postoperatively. The stone-free rates were 78 % and 89 % and the retreatment rates 31 % and 18 % in Groups 1 and 2, respectively. Complications (29 % and 38 %) were a function of the te chnical factors that become more apparent in the more difficult cases. Our data support the concept that the surgeon should have no previous intention to use the lithotripter and, therefore, should try to remov e the entire stone percutaneously safely and economically.