Sandwich therapy

When applying new technology to the management of patients with complex stone disease (especially those with infection-related stones), multiple factors should be considered. The primary goals of intervention in this setting, however, should be to minimize the rates of residual and recurrent stones and infection and to preserve renal function. A sequential, combined approach using percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy has proved valuable in minimizing the complication rates and maximizing the stone-free rates compared with using either modality alone.