Introduction and Objectives
Multiple renal access tracts may increase the morbidity of PNL treatment in staghorn lithiasis. For this reason, PNL followed by ESWL, for residual stones is a recommended treatment method in staghorn lithiasis. The aim of our study was to determine if ESWL treatment for residual struvite stones, after primary PNL approach is associated with significant stone free rate, justifying this combined therapy.
Material and Methods
Over a period of six years, a number of 157 struvite staghorn calculi were treated in our hospital. The stones were either complete or had only one empty caliceal group (type A and type B in Moores-O’Boyle classification). First line treatment was PNL. For residual stones, defined as fragments larger than 5 mm, ESWLwas used as combined approach. Failure of ESWL was followed by second PNL, the so-called sandwich therapy. The stone free rates associated with combined approach (PNL+ESWL) and those associated with sandwich therapy(PNL+ESWL+PNL) were determinated. Complication rates associated with the first and second PNL were registered separately.
26 patients were stone free after a single PNL tract access. Single session multi-tract PNL was used in 82 patients to obtain the stone free status. Single session PNL was associated with a stone free rate of 69%(108 patients). In the remaining 49 cases, the nephrostomy tube was left in place and ESWL was used for residual stones treatment. At least two ESWL treatment sessions were performed. The size of residual stones vary between 0.9cm and 1.8 cm. 29 stones were placed in the upper pole and the rest in the middle calyx. In 6 cases the stone free status was achieved following ESWL, meaning a stone free rate of this combined approach (PNL+ESWL) of 72.5%. ESWL increased the overall stone free rate with 3.5%. A second session PNL was performed for the remaining 43 patients, the method being successful in 21 patients. The second PNL increased the overall stone free rate with 13% up to 82%. The overall stone free rate of the sandwich therapy was 86%. Complication rates associated with the second PNL were insignificant.
Results of ESWL treatment for residual stones after primary PNL approach in struvite staghorn lithiasis are disappointing. When compared with second PNL treatment approach, ESWL treatment for residual struvite stones, after primary PNL approach, is associated with very low stone free rates. Therefore, justifying this combined therapy (PNL+ESWL) for struvite staghorn calculi is difficult
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.