Percutaneous Nephrolithotomy and Extracorporeal Shock Wave Lithotripsy Versus Ureteral Stent and ESWL for the Treatment of Large Renal Calculi and Staghorn Calculi—A Prospective Randomized Study: Preliminary Results

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Abstract
Recently published data indicate that morbidity after ESWL of large (>2 cm) renal calculi 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 percutaneous nephrolithotomy and ESWL for the treatment of large renal calculi (>2.5 cm) and staghorn stones. To date, 74 patients have entered the study, and ≥3-month follow-up data are available on 54. Complications (bleeding, septicemia, deterioration of renal function) were significantly more frequent in the entire series following percutaneous manipulation and ESWL (24% versus 3%), whereas the need for auxiliary measures (mainly percutaneous nephrostomies) was greater following stent insertion plus ESWL (25% versus 16%). After an average follow-up of 3 months, only 15% of the patients treated with ESWL and ureteral stenting were free of stones and none was stone free at hospital discharge, whereas the stone-free rates at discharge and 3 months in the group undergoing percutaneous manipulation plus ESWL were 41% and 66%, respectively. These data suggest that longer follow-up is necessary for the assessment of the definitive value of ESWL plus stenting 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.