Shock Wave Lithotripsy: Initial Therapy prior to Nephrostolithotomy in Selected Patients

Although "sandwich" therapy (percutaneous debulking followed by extracorporeal lithotripsy, with further percutaneous procedures if needed) is the preferred approach for large renal stone burdens, occasionally, the initial use of shock wave lithotripsy may facilitate a difficult access. Eleven patients were treated using shock wave lithotripsy prior to nephrostolithotomy because of difficult-clinical situations and failed attempts at percutaneous access. This "reverse sandwich" approach, although not recommended for all large stone burden problems, has a selective place in our treatment options for urinary stone disease.