[Staghorn calculi. Combined treatment with percutaneous nephrolithotripsy and extracorporeal lithotripsy]

We present our experience in 61 patients with partial or complete staghorn stone who underwent combined treatment with PCN and ESWL. We excluded the cases with an additional factor complicating staghorn stone, such as horseshoe kidney, severe ectopic, mal-rotated or high, with pyeloureteral junction stricture, etc. The patients were submitted to 72 PCN and 113 ESWL sessions, 5 percutaneous nephrostomies prior to PCN and 5 ureteroscopy procedures to remove post-ESWL obstruction. Complications were observed in 24.5%; acute urinary infection post-PCN (13 patients, 21.3%), massive absorption of liquid (1 case) and arteriovenous fistula (1 case). One year following treatment 83.6% of the patients are stone free and 14.9% have residual stone fragments. No patients developed arterial hypertension and one patient was submitted to nephrectomy due to pyelonephritic atrophy. Our criteria concerning the indications for the different therapeutic methods are discussed. In our view, the role of each method must be reviewed in the light of current clinical experience and investigative data.