Combination therapy in the treatment of patients with staghorn calculi.

The treatment of patients with staghorn calculi remains a challenging problem. Combination therapy using percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy has been recommended as the best option for most patients. Using this technique, 10 (83%) of 12 renal units with partial or complete staghorn calculi were rendered stone-free, with no significant septic episodes or serious complications. Blood transfusion was necessary in three patients. "Sandwich" therapy using initial percutaneous debulking followed by extracorporeal shock wave lithotripsy and/or "second-look" nephroscopy offers patients a high likelihood of achieving a stone-free state while avoiding the morbidity and lengthy recovery associated with open surgery.