The Management of Staghorn Renal Calculi ─Analysis of 100 Cases

From May 1988 to May 1989, there were 100 cases (103 kidney units) of staghorn re-nal calculi treated in Mackay Memorial Hospital. The treatment modalities in this series included a. Extracorporeal shock wave lithotripsy (ESWL) monotherapy - 28 cases (29 Kidney units) b. Percutaneous nephrolithotomy (PCNL) monotherapy - 24 cases (25 Kid-ney units) c. Percutaneous nephrolithotomy debulking and Extracorporeal shock wave lithotripsy combined therapy - 44 cases (45 Kidney units) d. Nephrectomy - 4 cases. The stone free rate for ESWL monotherapy was 83%, for PCNL monotherapy was 75%, for combined method was 85%. In the postoperative period, 9 cases suffered from sepsis, 7 cases suffered from Steinstrasse formation that necessitated secondary procedure - either ureterorenoscopic manipulation (5 cases) or ESWL (2 cases). In the ESWL monotherapy group, we inserted double J catheter as the ureteral stent to prevent ureteral obstruction caused by stone fragments. Multiple treatment sessions are usually needed in the management of staghorn renal calculi. ESWL monotheraphy can be used along with double J catheter as the initial treat-ment for uncomplicated staghorn renal calculi with less complication and promissing result. PNCL still has its role in the treatment of complex stone and in place where there is no facilities of extracorporeal shock wave lithotripter. Nephrectomy is restricted in cases of staghorn renal calculi with non-functioning kidney. (J Urol R.O.C., 1:303-308, 1990)