Minimally invasive treatment of hemiacidrin soluble staghorn renal stones.

Abstract

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.