EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY MONOTHERAPY FOR STAGHORN CALCULI

Forty-eight patients with large renal staghorn calculi of more than 35 mm in maximum length on plain X-rays were treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy for a period of 2 years. Thirty patients, with a follow-up of more than 6 months after the last treatment, were included in this study. The surface area of the calculi was 1,290 mm(2) on average. Based on plain X-rays, 9 cases (30%) became free of calculi while 12 patients (40%) had a small amount of residual fragments (less than 100 mm(2) in area). Adding these cases to those in which all the residual calculi were eliminated, the total turned out to be 21 cases (70%) and the treatment of staghorn calculi with ESWL was thus considered to have been fairly effective in the present series. The remaining 9 cases (30%) contained a considerable amount of residuals (more than 100 mm(2)). The present study in the ESWL of large staghorn calculi revealed no clear relationship between the surface area of the stones and evacuation of the fragments. The amount of the residual fragments was significantly small when either the renal collecting system was less than 2,000 mm(2) in area (p<0.05), or when the ureteropelvic junction (UPJ) was equal or greater than 5 mm in diameter (p<0.02) according to intravenous pyelography (IVP) before treatment. The complications associated with this treatment were minimal, with a high fever in only 3 patients that were treated easily by antibiotic therapy. ESWL monotherapy thus appears to be effective for the treatment of staghorn calculi, while causing few complications. Thus, cases showing less than 2,000 mm(2) in area for the collecting system or those showing an equal to or greater than 5 mm diameter of UPJ on IVP before treatment, are all thought to be good candidates for ESWL monotherapy.