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.