ABSTRACT
From January 1994 to January 1996, 46 high risk patients with stag-horn calculi where selected for extracorporeal shock wave lithotripsy monotherapy. All patients had factors whether related to affected renal unit or general health that would render any invasive procedure risky and of anticipated high morbidity. Six patients were excluded from the study as they showed no evidence of stone disintegration during the initial session. We report on the remaining 40 patients - ADJ stent was applied to all patients prior to ESWL. No anaesthesia was required during treatment sessions. An average of 3.5 treatment sessions with an average total number of 9234 shock waves were applied per patient. Twenty patients [50%] were stone free after 6 months of treatment. When we added 10 patients [25%] with residual fragments of 4 mm or less constituting 5% of original stone area in unobstructive locations, satisfactory results where achieved in 75% of patients. Percutaneous nephrostomy was applied to 5 patients [12.5%] due to ureteral obstruction and blocked DJ stent, fever of 38°C or more occured in 16 patients [40%] and responded to medical measure. Renal colic occured in 24 patients [60%], subcapsular haematoma in 2 patients and relieved spontaneously. We encountered no major complications requiring surgical or major endoscopic procedure on urgent basis. No blood transfusion, no haematurea requiring embolization and no loss of any renal unit occurred in the series. Although it is established that extracorpreal shock wave lithotripsy monotherapy should not be the primary treatment for staghorn calculi, yet in high risk patients it could be a salvage procedure with an apreciable outcome and low morbidity