Staghorn Stone Treatment with Extracorporeal Shock Wave Lithotripsy Monotherapy: Long-Term Results

Abstract

The results of 117 consecutive staghorn stones treated with extracorporeal shock wave lithotripsy (SWL) monotherapy between March 1985 and October 1988 were reviewed. At 8 months after the initial treatment, 46% of patients were stone free by plain abdominal radiolographs and renal ultrasound; 24% had minimal debris radiologically or by ultrasound, and 30% had a significant though fragmented residual stone burden. When patients were stratified by stone burden only, a maximum stone-free rate of 55% could be attained for staghorn stones filling a nondilated renal collecting system. When further stratified by caliceal anatomy, patients with stones filling a nondilated renal collecting system with no caliceal abnormalities could achieve a maximum stone-free rate of 78%. On the basis of these results, we conclude that staghorn stones filling a nondilated collecting system (Group 1) are eligible for SWL as monotherapy; however, more complex staghorn stones filling a mildly (Group 2) or grossly (Group 3) dilated renal collecting system or staghorn stones associated with altered caliceal anatomy should be primarily approached by percutaneous routes or, in selected cases, open surgery.