Treatment of Renal Staghorn Calculi with Extracorporeal Shock Wave Lithotripsy Monotherapy Using the Rocco Extra-Large Catheter
The experience of our group in Milan covers 1,055 cases treated between the first of February 1985 and the first of September 1987. At the present time, the procedures used to treat staghorn calculi are to reduce the mass of the stone by conventional surgery or by a percutaneous nephrolithotomy and then to treat with shock waves. This means, however, that the staghorn calculus is still dealt with by surgery. We present some technical means which have enabled us to treat 84 large stones with ESWL without employing invasive surgical or percutaneous methods. The aim is to avoid complications due to the presence of an excessive mass of fragments to be eliminated. Immediately before treatment we perform a cystoscopy and insert into the ureter and then into the kidney a urethral catheter of large dimension (14 Fr.). Through this catheter, both during and after treatment, large masses of debris can be evacuated. Introduction of the large catheter is carried out as follows: (1) A guide wire is introduced into the ureter as far as the pelvis. (2) The ureter is dilated 12 or 14 Fr. with ureteral dilators. (3) The catheter is inserted into the pelvis along the guide wire. In some cases a second small catheter is introduced into the renal cavities through the catheter already in place. In this way, each single calix can be washed and the debris removed. We have treated 48 patients with this method.
Fifty-three of 84 patients were stone free after three months post-treatment; 24 patients of 84 had residual dust; and seven patients of 84 had residual fragments (> 5 mm) which needed further treatment. The number of treatments required was one treatment for 55 kidneys, two treatments for 21 kidneys, three treatments for six kidneys, and four treatments for two kidneys. Complications after treatment were fever over 38.5°C in 18 patients, pain (colic) in 19 patients, surgery in one patient, and PCN in one patient. No patient required ureteroscopy.
KeywordsGuide Wire Shock Wave Lithotripsy Extracorporeal Shock Wave Lithotripsy Acute Pyelonephritis Percutaneous Nephrolithotomy
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