Infected Staghorn Stones Treated with Extracorporeal Shock Wave Lithotripsy and Hemiacidrin

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Abstract
Thirty patients with staghorn stones were treated with extracorporeal shock wave lithotripsy (ESWL) to increase the surface area followed by hemiacidrin irrigation. Following the insertion of one or two small percutaneous nephrostomy catheters and a double-J stent, disintegration of the stone was performed with a Dornier HM3 lithotripter equipped with a 15.6-cm ellipsoid and standard generator (80 nF) system. Immediately after ESWL, irrigation with a 10% solution of hemiacidrin was initiated. Treatment was continued until the patients were either stone free or had only small residual fragments no longer affected by hemiacidrin. This treatment protocol rendered 52% of kidneys stone free at 4-week followup, and another 24% had only small (<4 mm) residual fragments. The combination of ESWL and hemiacidrin irrigation provides an alternative for patients otherwise requiring percutaneous debulking prior to ESWL. Currently, all patients are treated without general or regional anesthesia.