Percutaneous Nephrolithotomy/ESWL ν Stent/ESWL for Large Stones and Staghorn Calculi: What Have We Learned?

In a prospective randomized study at the University of Ulm, patients with large stone burden have been treated either by extracorporeal shock wave lithotripsy (ESWL) monotherapy under the protection of a previously placed ureteral stent (stent/ESWL) or by the combination of percutaneous nephrolithotomy (PCNL) and ESWL (PCNL/ESWL). For this report, 91 renal units were evaluated after a mean follow-up of 8.4 months. In both groups, somewhat more than half of the patients (PCNL/ESWL 56%, stent/ESWL 54%) were stone free at follow-up. The conclusion of this study is that mere percutaneous stone debulking is an inefficient method for improving stone-free rates, whereas the active percutaneous removal of stone fragments seems to be the primary factor in obtaining better results. ESWL monotherapy has proved to yield satisfactory results as long as patients have normal or only slightly dilated collecting systems.