TREATMENT OF STAGHORN CALCULI BY PERCUTANEOUS NEPHROLITHOTOMY AND SWL- THE HOTEL-DIEU-DE-FRANCE EXPERIENCE

To evaluate the combined approach of percutaneous nephrolithotomy (PCN L) and extracorporeal shockwave lithotripsy (SWL) in the treatment of staghorn calculi, we carried out a retrospective review of 101 patient s. The stone surface area ranged from 654 to 3042 mm(2) (1535 mm(2) on average), During PCNL, a single access tract was used in 22 patients, a double tract in 65 patients, and a triple tract in 14 patients, A d oubled stent was placed percutaneously in 62 patients. Extracorporeal lithotripsy was scheduled at the patient's convenience on an outpatien t basis approximately 2 weeks after PCNL, The mean hospital stay was 4 .4 days. The combined approach showed a stone-free rate of 67% on the initial evaluation, an insignificant residual fragment rate of 26%, an d a residual stone rate of 7%, With a follow-up of 52 months on averag e, the global stone growth rate was 17%, being 4.4% only among the sto ne-free group and 27% among the group with insignificant residual frag ments. The global transfusion rate was 10%. Percutaneous stone debulki ng combined with SWL on an outpatient basis is an efficient, minimally invasive treatment for staghorn renal calculi, Reducing the number of access tracts, using the flexible nephroscope liberally, and placing a double-J stent frequently after PCNL increases the stone-free rate w hile reducing the morbidity and hospital stay.