Relative Roles of Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrostolithotomy

Abstract

Extracorporeal shock wave lithotripsy (ESWL^†) with the Dormer lithotripter¹ and percutaneous nephrostolithotomy (PCNL)Z^2,3 have revolutionized the management of upper urinary tract calculi. Both techniques may be applied to a wide variety of upper urinary tract calculi, though their relative roles remain yet to be established. In essence, the primary question when using ESWL or PCNL is not who can be treated, but rather who should be treated with these exciting new techniques. Because of the tremendous spectrum of disease presented by symptomatic upper urinary tract calculi requiring intervention, overall statements about the relative benefits of ESWL and PCNL are meaningless; rather, an intelligent decision regarding the indications for these techniques requires that the efficacy, morbidity, and costs associated with ESWL and PCNL for each type of stone problem be established. This presentation will present the treatment approach at the Methodist Hospital of Indiana (MHI), based on careful documentation of patients with upper urinary tract calculi treated with a variety of techniques.

This presentation was part of a planned debate on the following topic: Resolved: Percutaneous nephrostolithotomy alone or in combination with extracorporeal shock wave lithotripsy provides the preferred approach to large renal calculi and staghorn stones.