Is percutaneous monotherapy for staghorn calculus still indicated in the era of extracorporeal shockwave lithotripsy?

Staghorn stones can be treated by percutaneous nephrolithotomy (PCNL) or by extracorporeal shockwave lithotripsy (SWL); however, the combination of the two techniques appears as the most frequent treatment. In a previous study, the investigators noted that staghorn calculi treated with PCNL monotherapy have a good clearance rate. Herein, we have reviewed 102 staghorn stones that underwent PCNL before (1984-1986) (Group 1; n = 51) and after (1987-1990) (Group 2; n = 45) the introduction of SWL. The stone burden has increased in both size and complexity: there were 27 complete staghorn calculi (60%) in Group 2 compared with 19 (37%) in Group 1. Despite the higher number of kidney punctures, blood urea nitrogen and serum creatinine measurements demonstrated improvement of renal function postoperatively. The stone-free rates were 78% and 89% and the retreatment rates 31% and 18% in Groups 1 and 2, respectively. Complications (29% and 38%) were a function of the technical factors that become more apparent in the more difficult cases. Our data support the concept that the surgeon should have no previous intention to use the lithotripter and, therefore, should try to remove the entire stone percutaneously safely and economically.