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Prone Retrograde Laser Lithotripsy Facilitates Endoscope-guided Percutaneous Renal Access For Staghorn Calculi: Two Scopes Are Better Than One.

James F. Borin
Published 2008 · Medicine
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THE MANAGEMENT OF STAGHORN CALCULI has evolved significantly during the past three decades since Fernstrom and Johannson1 used the first percutaneous tract created specifically for nephrolithotomy.1 The previous gold standard of open surgery has been largely abandoned in favor of minimally invasive techniques that promise less morbidity. Shockwave lithotripsy monotherapy or in combination with percutaneous nephrolithotomy (PCNL), multitract PCNL, and single-tract PCNL in combination with flexible nephroscopy or ureteroscopy have all been described with varying degrees of success, as measured by stone-free rates and complications. What is clear is that complete stone removal should remain the primary goal of treatment, particularly in the case of struvite stones.2 The American Urological Association Nephrolithiasis Guideline Panel, in their report on staghorn calculi, analyzed all relevant literature from 1992 to 2003 and concluded that PCNL should be used as first-line treatment because of an overall stone-free rate of 78%, which was superior to all other methods and had similar rates of complications.2
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