title: Combined treatment of staghorn calculi by fiberoptic transurethral nephrolithotripsy and extracorporeal shock wave lithotripsy.
abstract: BACKGROUND
  Although various strategies have been proposed, the treatment of staghorn calculi is still controversial. We report on the treatment of 27 staghorn calculi using fiberoptic transurethral nephrolithotripsy (f-TUL) combined with extracorporeal shock wave lithotripsy (ESWL).
  
  
  METHODS
  Stones were initially disintegrated by f-TUL as an inpatient procedure. For stone fragmentation, we originally used an electrohydraulic lithotriptor (EHL) but changed to a pulsed-dye laser in 1993. After the stones were disintegrated as much as possible, a double-J ureteral stent was inserted and the patient was discharged. ESWL for the residual fragments was begun on an outpatient basis at 1 or 2 weeks after f-TUL and repeated until the residual fragments were smaller than 4 mm.
  
  
  RESULTS
  Since 1989, 27 staghorn calculi in 26 patients have been treated. Among them, 21 were successfully fragmented using this combined treatment regimen. From 3 to 26 ESWL sessions (mean, 8.4 sessions) were required to disintegrate the staghorn calculi. Auxiliary percutaneous endourological procedures were necessary in 2 cases due to ureteral obstruction. The other 4 patients are still receiving ESWL for residual fragments. Urinary tract injury occurred in 2 patients early in this series when an EHL was used, but was managed without any surgical procedures. A fever greater than 38 degrees C developed in 9 patients.
  
  
  CONCLUSIONS
  Combining f-TUL with ESWL provides an alternative treatment option for staghorn calculi. The use of a small caliber fiberscope (2.6 mm in diameter) and a laser for fragmentation decreased the risk of complications.
authors.affiliation: Department of Urology, Hamamatsu University School of Medicine, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Mugiya
authors.forename: K
authors.initials: K
authors.lastname: Suzuki
authors.forename: T
authors.initials: T
authors.lastname: Ushiyama
authors.forename: K
authors.initials: K
authors.lastname: Fujita
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D018666:Ureteroscopy