Study of factors requiring more than two ESWL treatments]

Nine hundred and fifty cases with renal and ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL) with Siements Lithostar unit from September, 1988 to October, 1990 at Kinki University Hospital. ESWL treatments were performed twice or more on 110 cases (DIFFICULTY GROUP). Ninety-seven cases who were cured by only one ESWL treatment were selected randomly as the control group. The two groups were retrospectively compared to study the factors requiring more than two times of ESWL treatments. There was a significant difference in the time of spontaneous stone discharge before ESWL treatment, the degree of hydronephrosis and the incidence of staghorn calculi as well as middle-lower ureteral calculi between the two groups. There was not a significant difference but a tendency to a longer period of stone existing at the same position and a higher percentage of past history of percutaneous nephrolithotropsy (PNL) in DIFFICULTY GROUP. Because ESWL monotherapy is considered to have limitations, auxiliary procedures or other treatments such as PNL and transurethral lithotripsy are recommended for patients in who in the stones were poorly disintegrated by the first ESWL treatment.     

Primary extracorporeal shock wave lithotripsy of staghorn renal calculi.

186 patients with partial and 55 patients with complete renal staghorn calculi were treated with primary extracorporeal shock wave lithotripsy (ESWL) at the Department of Urology, University of Würzburg Medical School. Partial staghorn calculi required an average of 1.4, complete staghorn calculi an average of 2.2 treatment sessions using the Dornier HM 3 lithotriptor. 55% of all patients and 46% of the patients with complete staghorn calculi were rendered stone-free within 1 year after ESWL. Pretreatment urinary tract infections present in 50.6% of all patients could be reduced to 22.5% 1 year after ESWL. The most frequent complications after ESWL were ureteral obstruction caused by 'steinstrasse' (41.4%), fever (38.4%), and renal colics (29.4%). Severe complications needing open operative procedures or blood transfusions did not occur. 50% of all patients underwent auxiliary procedures (e.g. insertion of indwelling ureteral stents: 25.3%, percutaneous nephrostomy: 20.3%, percutaneous nephrolithotripsy: 2.9%). Pretreatment insertion of an indwelling ureteral stent was found to reduce posttreatment complications as well as the need for percutaneous nephrostomy only in patients with partial staghorn calculi. The data presented in this study demonstrate that primary ESWL therapy can be safely and successfully performed in the majority of patients with renal staghorn calculi. In patients requiring complete removal of all stone fragments, a percutaneous lithotripsy can be performed following ESWL.     

Clinical experiences of renal and ureteral stones by extracorporeal shock-wave lithotripsy (ESWL). IV: 3-year clinical experience of cases treated with ESWL

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1,225 patients (1,320 cases) underwent 1,647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected.     

Clinical study of extracorporeal shock wave lithotripsy for 1000 patients with renal and ureteral stones

Using a Dornier HM3 lithotripter, we treated 1,000 patients with renal and ureteral stones from April, 1986 to July, 1989. They consisted of 612 solitary stones (pelvic stones, 152; calyceal stones, 167; ureteral stones, 293), 265 multiple stones and 123 staghorn calculi (complete, 48; partial, 75). The overall rate of the auxiliary procedure was 59.3% (pre-operative, 47.9%; post-operative, 11.4%). Pre-operative procedure included 430 catheterizations, 26 percutaneous nephrostomies (PNSs) and 23 pyelograms . Post-operative procedure included 69 transurethral lithotripsy , 21 PNSs, 26 percutaneous nephrolithotripsy (PNLs), 6 meatotomy , 5 chemolysis and 1 open surgery. 484 (68.3%) in 709 good follow-up cases were stone-free at the time of 3 months since the first extracorporeal shock-wave lithotripsy (ESWL). Complications were pain (34.8%), fever (4.3%), pain & fever (8.5%), subcapsular hematoma (0.1%) and ureteral obstruction (0.1%). Thus, ESWL is considered to be a useful means for renal and ureteral stones and in the case of large stone the combination therapy with PNL is more effective than ESWL-monotherapy.     

Clinical study of extracorporeal shock wave lithotripsy for stones in solitary kidney

Extracorporeal shock wave lithotripsy (ESWL) treatment was performed on 17 patients with a solitary or sole functioning kidney from August 1986 to April 1988. Some patients with renal stone had a double pig tail catheter to protect the stone street and those with ureteral stones had a ureteral balloon occlusion catheter to raise the efficiency of fragmentation placed prior to ESWL as much as possible. Combined manipulation with such an instrument as nephrostomy tube to wash out residual stone fragments or endoscopic operation were performed. Despite of these devices, ESWL treatments for staghorn calculi and cystine stones were troublesome in solitary kidneys. After follow up ranged from 9 to 602 days (mean 87.6 days), 10 patients (58.8%) were stone free. ESWL treatment is safe and effective for solitary kidneys. We recommended premedication and pretreatment by ureteral stenting in patients with a solitary kidney.     

Pediatric staghorn calculi: the role of extracorporeal shock wave lithotripsy monotherapy with special reference to ureteral stenting

PURPOSE: Treatment for staghorn calculi in children represents a unique challenge. We assessed the efficacy of extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Inc., Marietta, Georgia) monotherapy for the management of staghorn calculi in children with special reference to ureteral stenting. MATERIALS AND METHODS: From June 1992 to January 2001 we treated 42 children 9 months to 12 years old with staghorn stones using the Piezolith 2501 (Richard Wolf GmBH, Knittlingen, Germany) lithotriptor. The initial group of 19 patients underwent ESWL without prophylactic ureteral stenting, while in the latter group of 23 a Double-J (Medical Engineering Corp., New York, New York) ureteral stent was inserted immediately before the first ESWL session. Mean patient age, stone size, number of shock waves and ESWL sessions, hospital stay, stone-free rate and major complications were compared in the 2 groups. RESULTS: Overall 33 children (79%) were stone-free after 3 months. The 2 groups were comparable in regard to patient age, stone size, number of shock waves and ESWL sessions, and stone-free rates. Major complications developed in 21% of the unstented group, whereas none were observed in stented cases. This difference was statistically significant (p = 0.035). Seven post-ESWL auxiliary procedures were required in the unstented group to manage complications. Hospital stay was significantly longer in the unstented compared with the stented group (p = 0.022). At a followup of 9 to 102 months (mean 47) stones recurred in 2 children, who were treated with further ESWL. CONCLUSIONS: ESWL monotherapy was an efficient and safe modality for the treatment of staghorn calculi in children. Stented patients had fewer major complications and a shorter hospital stay. Prophylactic ureteral stenting is advisable before ESWL for staghorn calculi in children.     

ESWL monotherapy for large-volume renal calculi: efficacy and morbidity

We assessed the efficacy and morbidity of extracorporeal shock-wave lithotripsy (ESWL) monotherapy in the treatment of 25 consecutive patients with large-volume renal calculi (surface area greater than or equal to 5.0 cm2). Eighteen of the calculi were infection (struvite) stones and 7 were sterile stones. In 21 cases internal ureteral stents were positioned before ESWL, but no patient underwent pretreatment percutaneous nephrostomy (PCN) or percutaneous nephrostolithotomy (PNL). An average of 2.1 procedures including ESWL, PCN, or ureteral interventions were required to achieve a stone-free renal collecting system and ureter, or residual stone particles less than 4 mm in diameter confined to the renal collecting system. Sixty percent of the patients required no ancillary procedures after ESWL. There were no differences in the mean duration of hospitalization, need for post-treatment ancillary procedures, time to clearance of ureteral fragments, and incidence of residual stone particles among patients with infection and sterile stones. Of 23 patients observed greater than three months (mean 10.9 mos) after ESWL, 43 percent had residual stone particles in the renal collecting system. Expansion of these particles or stone recurrence in the absence of residual particles has not been observed. We conclude that large volume renal calculi may be managed effectively and safely with ESWL monotherapy.     

Electromagnetic extracorporeal shock wave lithotripsy in children

Extracorporeal shock wave lithotripsy (ESWL) was performed for the treatment of urinary tract calculi in 28 children. All treatments were done with the standard Siemens Lithostar device in situ: no special adaptations for adequate positioning of children are required to target the stone precisely. A total of 42 calculi in 30 renal units was treated, requiring 50 ESWL sessions. The mean energy used was 16.4 kv. and the number of shock waves averaged 3,188. Mean fluoroscopy time per session was 1.5 minutes. In 26 of 50 sessions (52%) general anesthesia was needed for the child to remain perfectly still. A complete stone-free rate was achieved in 38 of 42 calculi (90.5%): after 1 session in 30 (71.4%), after 2 sessions in 6 (13.7%) and after 3 sessions in 2 (4.8%). Five staghorn calculi were treated with ESWL monotherapy. A complete stone-free result was obtained after 3 treatments in 2 patients, while 2 had residual fragments in the lower pole (5 mm. after 6 sessions and 11 months of followup in 1, and 7 mm. after 3 sessions and 3 months of followup in 1). A cystine staghorn stone necessitated open nephrolithotomy after 3 sessions without any fragmentation. One impacted sacroiliac ureteral stone required endoscopic laser lithotripsy. Except for these 2 failures no adjuvant procedures were needed. There were no intraoperative or postoperative complications and minor skin bruising at the coupling site after 3 treatments did not require any therapy. We conclude that electromagnetic ESWL with the standard Lithostar unit is a safe and effective method to treat calculi throughout the urinary tract in children.     

Endoscopic treatment for severe encrusted ureteral stent left in place for 3 years

A 52-year-old man had bilateral ureteral stents placed before treatment for ureteral and renal stones, but did not return for treatment and follow-up. Three years later, he complained of hematuria and vertigo. An abdominal X-ray revealed large renal and ureteral stones rising from and enveloping the stent. A bilateral percutaneous nephrostomy was placed. The right ureteral stent was easily removed with a cystoscope. The left ureteral stone was separated from the stent by ureteroscopic lithotripsy (TUL) and percutaneous nephroscopic lithotripsy (PNL). The left stent was torn off and difficult to remove because of encrustation. It was finally removed through an endoscopic procedure. Right PNL and extracorporeal shock wave lithotripsy (ESWL) were performed and all stones and stents were extracted. He was stone-free at 4 months.     

Extracorporeal shock wave lithotripsy of staghorn stones in solitary kidney]

Extracorporeal shock wave lithotripsy (ESWL) has been established as noninvasive treatment of choice for the great majority of upper urinary tract stones. However the management of staghorn stones in solitary kidney still deserves special consideration. We reviewed retrospectively 11 patients with staghorn stones in solitary kidney treated mainly with the Dornier HM-3 lithotripter during the period between December 1984 and December 1989 at the Sagamidai Hospital. The contralateral kidneys of the 8 patients were nephrectomized or nonfunctioning due to stone disease and those of 3 patients were nephrectomized due to tuberculosis. They were consisted of 6 males and 5 females with average ages of 60.0 years and 48.6 years respectively. The size of the stones ranged from 30 x 30 mm to 85 x 40 mm in KUB. ESWL was the first treatment for all the cases except for one patient a cystine stone. In that patient, ESWL was preceded by percutaneous nephrolithotripsy (PNL). In three patients the treatment was successfully by ESWL alone without any obvious complication. In 6 patients percutaneous nephrostomy was required and in two patients PNL was performed as an auxiliary procedure. Seven patients developed high fever (over 38.5 degrees C) and two of them became septic during the course of treatment. In five patients serum creatinine elevated over 2.0 mg/dl, but returned to within normal limits postoperatively. Extracorporeal shock wave lithotripsy can play a major role in the patient of the staghorn stones in solitary kidney.(ABSTRACT TRUNCATED AT 250 WORDS)     

Extracorporeal shock-wave lithotripsy with Lithostar lithotriptor.

Initial experience of extracorporeal shock-wave lithotripsy (ESWL) using the Lithostar lithotriptor is reported; 193 patients underwent 248 treatments for 210 stones. A total of 139 renal calculi (126 patients) and 71 ureteral stones (67 patients) were analyzed. Treatments were performed without anesthesia in 65 calculi (27.6%), with intravenous sedation in 91 (42.5%), and under epidural anesthesia in 34 calculi (29.9%). A three-month follow-up showed a success rate of 88.0 percent for renal calculi and 95.5 percent for ureteral calculi treated in situ. Renal stone fragmentation was achieved with a mean of 4,890 shocks at 17.4 kV and ureteral calculi were fragmented with a mean number of 4,798 shocks at a mean of 18.3 kV. Auxiliary procedures after ESWL were required in 2 patients with renal stones and in 1 with ureteral calculi. A comparison between stone size and number of shock waves required to achieve stone fragmentation revealed a linear relationship. Hospitalization was not necessary in 84.4 percent of renal calculi and 89.6 percent of ureteral calculi. Retreatments were necessary in 22 (15.8%) of the renal calculi (18 had 2 sessions, 3 had 3 sessions, and 1 had 4 sessions). Of the ureteral calculi, 8 (11.3%) underwent retreatment (6 had 2 sessions, 1 had 3 sessions, and 1 had 4 sessions). The low morbidity with a large number of patients treated on an outpatient basis, minimizing the need for anesthesia, demonstrated a favorable initial successful experience with the Lithostar.     

Surgical management of urinary calculi

Shock wave lithotripsy is the cornerstone of the modern management of urinary calculi and is the preferred treatment for most small renal stones. Percutaneous lithotripsy is preferred for large stones and in combination with ESWL for staghorn calculi. Upper ureteral stones should be pushed back to the kidney for ESWL, if possible; otherwise they should be treated in situ. Lower ureteral stones are preferentially managed with ureteroscopy, but ESWL may also be used. A variety of methods of power lithotripsy are available: ultrasound, electrohydraulic lithotripsy, and pulsed dye laser lithotripsy. Only 1% to 2% of stone patients require open surgery; it is an important judgment to identify these patients to avoid inappropriate use of newer techniques in cases where success is unlikely. It is apparent that modern management of the patient with a urinary calculus requires access to all methods of stone removal. The surgeon and internist should not forget that the goal is to remove the stone safely, efficaciously, and economically.     

Medical management for the prevention of the recurrence of urolithiasis--with special recurrence to the patients who underwent percutaneous nephrolithotripsy (PNL) or extracorporeal shock wave lithotripsy (ESWL)

Questionnaires about stone recurrence after treatment with percutaneous nephrolithotripsy (PNL) or extracorporeal shock wave lithotripsy (ESWL) were sent to 11 hospitals in the central section of Japan. We received 255 replies on PNL cases and 157 replies on ESWL cases. These patients were evaluated for the recurrence of renal stones and the enlargement of residual stone fragments. The effect of the medical management for the prevention of recurrent stone disease on postoperative recurrence rate was also evaluated. The average follow-up period of patients treated with PNL was 21.6 months, and 18.5 months for patients treated with ESWL. In patients who underwent PNL, 25 of 162 patients (15.4%) who were treated completely without any residual stones have suffered from new stones. The residual stone or fragments enlarged in 14 of the 93 patients (15.1%) who had residual stones or fragments after the treatment. The recurrence rate was significantly higher for the recurrent stone former than the single stone former. The recurrence rate for the patients who had multiple stones, staghorn calculi and metabolic disorders such as hypercalciuria also had a high incidence. Patients who received medical treatment for the prevention of stone recurrence had a lower recurrence rate than the group not treated. Especially among the patients with hypercalciuria, the recurrence rate of stone disease in the treatment group was significantly lower than that in the group not treated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fiberoptic transurethral lithotripsy prefers smaller impacted ureteral calculi rather than large renal stones

A total of 30 patients with urolithiasis underwent 35 sessions of fiberoptic transurethral lithotripsy (f-TUL) involving electrohydraulic lithotripsy. There were 11 patients with nephrolithiasis including 4 with staghorn calculi and 19 patients with ureterolithiasis which were all located above the pelvic brim. A fiberoptic nephroureteroscope (URF-P) was successfully introduced up to the stone in all but 2 cases (93.3%). Of the 28 patients with successful introduction, 21 received a single session of f-TUL for complete fragmentation of their stones, which measured less than 16 x 9 mm by radiography. Three patients with larger renal stones (greater than or equal to 17 x 9 mm) underwent 2 sessions of f-TUL for complete fragmentation. The remaining 4 patients who had staghorn calculi (greater than or equal to 38 x 33 mm) received 1 session of f-TUL with partial fragmentation; then 3 were sent to an ESWL clinic with good results, while the other patient received 2 more sessions of f-TUL and formed a stone street. Attempts were subsequently made to destroy the latter by ESWL but were unsuccessful. In conclusion, f-TUL appears to be most suitable for smaller impacted ureteral calculi above the pelvic brim.     

Two years clinical experiences with extracorporeal shock-wave lithotripsy and transurethral ureterolithotripsy for ureteral stones at Osaka City University Hospital

From July 1985 to June 1987, 303 patients with ureteral stones were treated by either extracorporeal shock-wave lithotripsy (ESWL) or transurethral ureterolithotripsy (TUL). The ureteral stones were classified into two groups, upper and lower ureteral stones. The upper ureteral stone was defined as a stone located above the pelvic brim in radiological examinations. ESWL was performed using a Dornier lithotriptor HM-3. For TUL, following the insertion of a guide wire and dilatation of the intramural ureter by ureteral bougie, a ureteroscope was introduced into the ureter. The success rate included both patients who became stone free and patients whose stones were disintegrated into less than 4 mm. The success rate of ESWL for upper ureteral stones was 90%, and 8.5% were treated subsequently by TUL. The success rate of TUL for upper ureteral stones was 42%, and the remaining required another session of TUL or another procedure, mainly ESWL. On the other hand, the success rate of TUL for lower ureteral stones was 71%, and the remainder also required another session of TUL or another procedure, mainly ESWL. The efficacy of TUL for stone street was comparably low by the evaluation done at 5 days after the procedure. However, almost all patients with stone street, which had developed after ESWL treatment, became stone free several weeks after TUL and insertion of a stent catheter. Major complications or side effects for ESWL were fever of more than 37.5 degrees C (7.5%) and pain attacks (8.9%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Extracorporeal shock wave lithotripsy for ureteral stones and cystine stones]

We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1,875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1,833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of ureteral stone disease: the role of ESWL and endourology

Summary In recent years, extracorporeal shockwave lithotripsy (ESWL) has proved a safe and easily reproducible method for the treatment of calculi in the upper urinary tract above the iliac crest. Current indications for ESWL as single therapy encompass approximately 60%–70% of all stones. The use of endourological methods as auxiliary procedures can enhance the range of indications to 95% of all renal stones and 85% of all ureteral stones. In the last year, 1340 patients have been successfully treated for urinary calculi at our department. Evaluation of all stone cases shows that ESWL alone, ESWL combined with percutaneous techniques, or percutaneous techniques alone were performed on 93% of all patients. Only 7% of patients had to undergo open surgical treatment, 1% for renal stones and 15% for ureteral stones. Ureteral stones are still among the problem stones for ESWL, in many cases requiring time-consuming combined procedures with either of the percutaneous methods. Furthermore, ureteral obstruction caused by stone particles as a complication after ESWL-treatment of large renal stones has to be relieved using percutaneous techniques. In this report we describe our approach in detail and discuss our results.     

Extracorporeal shock-wave lithotripsy (ESWL) monotherapy for stones in lower ureter.

Extracorporeal shock-wave lithotripsy (ESWL) has been accepted as the method of choice for most upper urinary tract calculi. However, in cases of stones in the lower ureter, ureteroscopic procedures have generally been preferred. Using the Dornier HM3 lithotriptor with modifications in the patient's position, we were able to successfully treat 155 unselected cases of lower ureteral calculi. The average stone size was 9.6 mm (range 5-23 mm). One hundred forty-three patients had stones located below the lower margin of the sacroiliac joint. These patients were placed in a supine position. The stones were visualized radiologically without use of a ureteral catheter in 78 percent of the patients; in 22 percent a ureteral catheter was inserted prior to ESWL to aid in stone localization. In 145 patients (94%) treatment was completed in one session; 10 patients (6%) required two sessions. Of the patients, 38 percent were free of stones one day after ESWL; 97 percent became stone free within three months, and only 3 patients required endoscopic manipulation, after ESWL. Twelve patients had stones in the midureter overlying the sacroileum. They were placed in the prone position, and the calculi were visualized with the aid of a ureteral catheter. All these patients became free of stones one month after treatment. There were no significant treatment-related complications except for bacteremia in 1 case. In view of the remarkable efficacy, negligible complication rate, and shorter hospital stay as compared to ureteroscopic stone manipulations, we recommend high energy ESWL as the primary monotherapy of mid and lower ureteral stones.     

Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones

Objective To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. Patient and methods We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. Results The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P = 0.17). For the group with stones <100 mm2, the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P = 0.12) and the proximal ureter group (P = 0.96), it adversely affected SFR in the distal ureter (P = 0.017). Conclusions ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm2. Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.     

Extracorporeal shock wave lithotripsy as monotherapy of staghorn renal calculi: 3 years of experience

From May 1985 to February 1988, 61 patients with renal staghorn calculi (41 with incomplete C4 and 20 with complete C5 lesions) underwent extracorporeal shock wave lithotripsy monotherapy. Of the patients 37 were treated without preoperative Double-J* stenting, while 24 underwent Double-J stenting before extracorporeal shock wave lithotripsy. Of the patients with incomplete staghorn calculi (C4) and a preoperative ureteral stent 85% were free of stones after 6 months in contrast to only 52.4% of those without a stent and 85.7% of those with infected C4 calculi who underwent preoperative stenting. Hospitalization decreased from 17.7 days in patients without a stent to 14.2 days after stenting, followed by the number of auxiliary procedures (nephrostomy, Zeiss loop and ureteroscopy) and postoperative complications. Complete staghorn calculi (C5) without a preoperative stent had the smallest success rate of stone elimination: only 43.7% of the patients were free of stones after 6 months with a rehospitalization rate of 62.5%. For incomplete staghorn renal calculi (C4) extracorporeal shock wave lithotripsy monotherapy with a preoperative Double-J stent is the noninvasive method that offers excellent stone elimination (85%), comparable to the results of percutaneous nephrolithotripsy (with or without complementary extracorporeal shock wave lithotripsy) and anatrophic nephrolithotomy.