Minimally Invasive Treatment of Infection Staghorn Stones with Shock Wave Lithotripsy and Chemolysis

Abstract

We report the results in 118 patients with infection staghorn stones treated with an anaesthesia-free minimally invasive method that combined repeated shock-wave lithotripsy (SWL) sessions (unmodified Dornier HM3 lithotripter) and percutaneous chemolysis with Renacidin. The stone-free rate was 60%. In 27 consecutive patients with infection staghorn stones representative of patients with this stone type in the population, a stone-free rate of 77% was recorded. The latter figure is comparable with results reported for open surgery, percutaneous surgery and sandwich therapy, and superior to that recorded with SWL alone. During the study period, no patient referred to us with an infection staghorn stone was treated with percutaneous, ureteroscopic or open surgery, and all treatments were carried out without regional or general anaesthesia. The described treatment concept had a very low complication rate, but required a fairly long hospital stay, with a mean of 32 days (range: 5-82). The long period necessary for completing the treatment in the most complicated cases might render the procedure less attractive as a standard method, but it is nevertheless an excellent option in high-risk patients and in all those patients in whom other procedures are impossible.