title: Combination therapy for staghorn calculi in solitary kidneys: functional results with long-term followup.
abstract: A total of 10 patients with staghorn calculi in a solitary kidney was managed with endourological sandwich therapy consisting of primary percutaneous debulking followed by extracorporeal shock wave lithotripsy (ESWL*) of residual inaccessible stones. Secondary percutaneous procedures, ESWL and chemical dissolution were used as necessary in a vigorous attempt to render each patient stone-free. As such, these 10 renal units underwent 21 percutaneous procedures through 13 tracts, 17 ESWL treatments and 3 courses of hemiacidrin. No patient required open operative intervention or dialytic support. With 4 to 57 months (mean 31.6) of followup, renal function for the group as a whole improved as evidenced by a decrease in mean serum creatinine levels from 3.1 mg./dl. before treatment to 2.2 mg./dl. at latest followup. More importantly, renal function has remained stable or improved in 9 of the 10 patients individually. We conclude that an aggressive, combined endourological approach to the management of staghorn calculi provides long-term preservation of function in the affected kidney.
authors.affiliation: Department of Urology, Cleveland Clinic Foundation, Ohio.
authors.forename: S B
authors.initials: SB
authors.lastname: Streem
authors.forename: M A
authors.initials: MA
authors.lastname: Geisinger
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D007682:Kidney Pelvis; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous