“sandwich” Therapy for the Treatment of Complex Renal Stones

Purpose: Shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) are well accepted, minimally invasive modalities available for the treatment of calculi. In this paper we review and discuss the technique of combination “sandwich therapy” for the treatment of select patients with large, extensively branched, or otherwise complex stones. Materials and Methods: A review of the literature on combined percutaneous nephrolithotomy and shock wave lithotripsy for the management of “staghorn” calculi was performed and evaluated. Results: Stone free rates after one month of follow up approach 70%, while the remaining patients are left with residual dust or gravel. Complications occur in less than 30% of patients, and no nephrectomies or mortality have been reported with this approach. The probability of new stone formation has been estimated to be 37% at five years, and renal function has been shown to remain stable or improve in 96% of patients. Conclusion: The use of combination therapy for the treatment staghorn calculi is safe and effective and can limit much of the associated morbidity of SWL or PCNL monotherapy. We recommend this combined “sandwich” approach as the treatment of choice for select patients with large, extensively branched, or otherwise complex staghorn calculi.