[Treatments of staghorn calculi]

The treatment of staghorn calculi is still difficult even though urolithiasis treatment can now be performed by endourology and extracorporeal shock-wave lithotripsy (ESWL) without open surgery. Because of the variety in volume and pattern of the staghorn calculi, especially with or without dilated renal pelvis and calyces, selection of treatment methods is important. The combined method of percutaneous nephrolithotomy (PNL) and ESWL has been highly effective in the complete removal of most staghorn calculi. Developments of the ESWL instrument and tools have increased the success of less invasive ESWL monotherapy with placing of stent or percutaneous nephrostomy for staghorn calculi with nondilated calyces. Also the treatment methods should be selected depending upon the components of the staghorn calculi. Dissolution and solidity, which are affected by the components, are also important factors. Complete removal of staghorn calculi is very difficult, and almost impossible to be performed in only one occasion including other surgical procedures as a series and this is the existing insurance provision. Therefore, we await the creation of a new insurance provision for the treatment of staghorn calculi.