1988, pp 89-93

Percutaneous Nephrolithotomy and ESWL versus Ureteral Stent and ESWL for the Treatment of Large Renal Calculi and Staghorn Calculi: Preliminary Results of a Prospective, Randomized Study

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Abstract

Recently published data indicate that morbidity after ESWL of large renal calculi (> 2 cm) can be significantly diminished by inserting a ureteral double-J stent prior to treatment. A prospective, randomized study was designed to clarify if ESWL plus ureteral stenting is preferable to the combination of PNL/ESWL for the treatment of large renal calculi (> 2.5 cm) and staghorn stones. To date 74 patients have entered the study; preliminary data of 53 patients are available.

 

PNL/ESWL

Stent/ESWL

Number of patients

38.0

36.0

Age (mean, years)

54.0

49.0

ASA (mean)

2.0

1.7

Mortality

0

0

Hospital Stay (days)

19.4

17.6

Complications

24%

3%

Auxiliary Measures

16%

25%

Stone Free (at discharge)

41%

0%

Stone Free (follow-up)

66%

15%

Complications (bleeding, septicemia, deterioration of renal function) are significantly more frequent following PNL/ESWL, whereas the need for auxiliary measures (mainly percutaneous nephrostomies) is greater following stent/ESWL. Results after an average follow-up of three months indicate that only 15% of patients treated with ESWL and ureteral stenting were free of stones, suggesting that longer follow-up is necessary for the assessment of the definitive value of this treatment modality in the treatment of large renal calculi. With the availability of anesthesia-free ESWL in the Dornier HM3, this topic is currently of particular interest.