Extracorporeal shock wave lithotripsy as monotherapy of staghorn renal calculi: 3 years of experience.

From May 1985 to February 1988, 61 patients with renal staghorn calculi (41 with incomplete C4 and 20 with complete C5 lesions) underwent extracorporeal shock wave lithotripsy monotherapy. Of the patients 37 were treated without preoperative Double-J* stenting, while 24 underwent Double-J stenting before extracorporeal shock wave lithotripsy. Of the patients with incomplete staghorn calculi (C4) and a preoperative ureteral stent 85% were free of stones after 6 months in contrast to only 52.4% of those without a stent and 85.7% of those with infected C4 calculi who underwent preoperative stenting. Hospitalization decreased from 17.7 days in patients without a stent to 14.2 days after stenting, followed by the number of auxiliary procedures (nephrostomy, Zeiss loop and ureteroscopy) and postoperative complications. Complete staghorn calculi (C5) without a preoperative stent had the smallest success rate of stone elimination: only 43.7% of the patients were free of stones after 6 months with a rehospitalization rate of 62.5%. For incomplete staghorn renal calculi (C4) extracorporeal shock wave lithotripsy monotherapy with a preoperative Double-J stent is the noninvasive method that offers excellent stone elimination (85%), comparable to the results of percutaneous nephrolithotripsy (with or without complementary extracorporeal shock wave lithotripsy) and anatrophic nephrolithotomy.