Minimally invasive treatment of hemiacidrin soluble staghorn renal stones.
Among 78 patients with hemiacidrin soluble staghorn renal stones, 23 were treated with a combination of one session of percutaneous debulking and high-energy extracorporeal shock wave lithotripsy (ESWL) (Group A); 17 were treated with high-energy ESWL only (Group B); and 38 were treated with low-energy only ESWL (Group C).  In all patients percutaneous nephrostomies were inserted and the ESWL procedure was followed by hemiacidrin irrigation. ESWL was performed with anesthesia in Groups A and B, but without anesthesia in Group C.  Groups A and B did not differ in number of ESWL sessions or length of hospital stay, and the therapeutic results at discharge and at 6-month follow-up were comparable, whereby 59% of the patients in both groups were either stone-free or had only small ( less than or equal to 3 mm) residual fragments.  In Group C more ESWL sessions were performed, and the hospital stay as well as the hemiacidrin irrigation periods were longer.  The fraction of stone-free renal units at discharge was significantly higher in Group C than in Group A (p less than 0.05) and after 4 weeks higher than in both Groups A (p less than 0.025) and B (p < 0.05).  At 6 month follow-up, 92% of the patients in Group C were either stone-free or had only small ( less than or equal to 3 mm) residual fragments.  Combined low-energy ESWL and hemiacidrin irrigation can successfully be used for treatment of even very large infection staghorn stones.
Department of Urology, University Hospital, Linköping, Sweden.
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Wall
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Tiselius
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Hellgren
D000328:Adult; D000368:Aged; D002951:Citrates / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000628:therapy*; D007902:Length of Stay; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D015607:Stents; D007507:Therapeutic Irrigation