Combined Percutaneous and Extracorporeal Shock Wave Lithotripsy for Staghorn Calculi: An Alternative to Anatrophic Nephrolithotomy

Kahnoski, Richard J.; Lingeman, James E.; Coury, Thomas A.; Steele, Ronald E.; Mosbaugh, Phillip G.

doi:10.1016/s0022-5347(17)45817-4

Cited by 134 publications

(27 citation statements)

References 18 publications

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“…In the mid-1980s the addition of combination therapy with SWL further expanded the indications for PCNL. 9,10 Currently, with recent advances in ureteroscopy, lasers, and lithotripters, and refinement of techniques, PCNL has virtually eliminated open stone surgery. 11 Pneumatic lithotripters fragment stones effectively and decrease ablation time; however, with harder stones, pneumatic lithotripsy results in larger stone fragments and longer extraction times.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Comparison of a Combined Ultrasonic and Pneumatic Lithotrite with a Standard Ultrasonic Lithotrite for Percutaneous Nephrolithotomy

Lehman

Hruby

Phillips

et al. 2008

Journal of Endourology

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,"Prospective randomized comparison of a combined ultrasonic and pneumatic lithotrite with a standard ultrasonic lithotrite for percutaneous nephrolithotomy." Journal of Endourology.22,2. 285-289. (2008 1 uric acid [UA]). In the SUL group, there were eight hard stones (5 CaOxMono and 3 CaPO 4 ), and six soft stones (4 calcium oxalate dihydrate [CaOxDi] and 2 UA) (P ‫؍‬ 0.51). Stone composition data were unavailable for five patients. Fragmentation time for the PAL was 37 minutes versus 31.5 minutes for the SUL (P ‫؍‬ 0.22). Stone retrieval and mean operative times were similar for both groups. There were a total of three (23.1%) device-related problems in the PUL group, and eight (47%) in the SUL group. There was one (7.7%) device malfunction in the PUL group due to probe fracture. There were two (11.7%) device failures in the SUL group; one failure required the device to be reset every 30 minutes, and the second was an electrical failure. Suction tubing obstruction occurred twice (15.3%) in the PUL group and 35.3% in the SU group (P ‫؍‬ 0.35). The stone-free rates for the PUL and SUL were 46% and 66.7%, respectively (P ‫؍‬ 0.26).Conclusion: Although the PUL was more costly, stone ablation and clearance rates were similar for both the combined pneumatic and ultrasonic device and the standard ultrasonic device. When stratified with respect to stone composition, the PUL was more efficient for harder stones, and the SUL was more efficient for softer stones.

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Section: Discussionmentioning

confidence: 99%

Prospective Randomized Comparison of a Combined Ultrasonic and Pneumatic Lithotrite with a Standard Ultrasonic Lithotrite for Percutaneous Nephrolithotomy

Lehman

Hruby

Phillips

et al. 2008

Journal of Endourology

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“…Persistent residual concrements after ESWL, PNL, and pyelo-or nephrolithotomy thus warrant the indication of percutaneous chemolysis. In addition, the question must be discussed whether all patients present ing struvite, apatite, and brushite stones should undergo prophylactic percutaneous chemolysis in order to prevent recurrent stone formation immediately after primary treatment of concrements, as has been done by Kahnoski et al [42], A prospective study should be considered to bring about further clarification in this matter.…”

Section: Discussionmentioning

confidence: 99%

When Is the Indication of Percutaneous Chemolysis Justified?

Heimbach¹,

Winter²,

Hesse³

1995

Urol Int

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Persistent residual stone fragments after extracorporeal Shockwave lithotripsy (ESWL), percutaneous nephrolitholapaxy (PNL) as well as pyelo- and nephrolithotomy represent a great problem in the treatment of stones. The choice of therapy for patients with insufficient renal drainage, poor renal function, and a high anesthetic risk also remains quite difficult. Between 1991 and 1993, 5 patients underwent percutaneous antegrading chemolysis with ‘Suby G’ solution. Two patients, presenting struvite and apatite stones, were free of stones afterwards. In 1 patient, where stone analysis revealed a predominant brushite component, a large decrease in stone size could be observed. In 2 other cases, with stones mainly consisting of whewellite and weddelite, chemolysis proved ineffective. Evaluating our own clinical experience and relevant medical literature, the present study goes on to prove that the indication of percutaneous chemolysis in risk patients as described above is dependent on stone analysis, and must be regarded as an effective adjuvant treatment.

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“…The standard of care for staghorn was set by Boyce and Elkins [9] in their report on anatrophic nephrolithotomy with 94% being stone-free at the time of discharge, and only 17% having recurrence 1-3 years later. Despite advances in treatment of stone disease during the last 20 years, the magic figures mentioned above have never been equalled with either monotherapy or even with combination, and the clearance rates have varied from 22 to 92% depending more upon the material chosen rather than the modality used [1,[10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Management of Staghorn Calculus: Analysis of Combination Therapy and Open Surgery

Goel

Ahlawat²,

Bhandari³

1999

Urol Int

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Objective: To assess the role of primary open surgery versus the recommended combination approach (percutaneous and lithotripsy) to treat staghorn calculi in a developing country. Patients and Methods: Available records (n = 91) of patients with staghorn managed during the last 4 years were retrieved. Patients were placed in two groups, open surgery and combination group, according to the primary procedure chosen by the patient. Demographic data in two groups was comparable in most of the respects except that renal failure patients were more in the combination group. Stone clearance, major residue, auxiliary procedures, morbidity, hospital stay and the cost were studied in the two groups for comparison. Results: Complete clearance could be obtained in 66 and 59% with open and combination method respectively. Major residue (>16 mm²) was present in 21% of open and 38% of the combination group. In patients with primary stone burden <900 mm², the total clearance rates were 66 and 60% in open and combination group, respectively. Total clearance was not affected by caliceal dilatation, total stone burden, pelvic and caliceal bulk separately or their ratio, as arrived by logistic regression analysis. The incidence of haematuria in the combination group was marginally higher, probably due to more renal failure patients in this group. Hospital stay in the two groups was comparable (13.0 days in combination vs. 12.1 days for open). The cost of treatment with combination group was significantly higher. Conclusion: Open surgery for staghorn is still an economically viable option for difficult stone disease, specially in a developing country, with comparable efficacy, favourable morbidity and hospital stay.

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Combined Percutaneous and Extracorporeal Shock Wave Lithotripsy for Staghorn Calculi: An Alternative to Anatrophic Nephrolithotomy

Cited by 134 publications

References 18 publications

Prospective Randomized Comparison of a Combined Ultrasonic and Pneumatic Lithotrite with a Standard Ultrasonic Lithotrite for Percutaneous Nephrolithotomy

Prospective Randomized Comparison of a Combined Ultrasonic and Pneumatic Lithotrite with a Standard Ultrasonic Lithotrite for Percutaneous Nephrolithotomy

When Is the Indication of Percutaneous Chemolysis Justified?

Management of Staghorn Calculus: Analysis of Combination Therapy and Open Surgery

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