786 EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND COMBINED THERAPY FOR STAGHORN CALCULI

J. P. and Valiquette, L.: Staghorn calculi treated by percuta- neous nephrolithotomy: risk factors for recurrence. Urology, 41: 141, 1993.

45. Streem, S. B.. Geisinger, M. A., Risius, B., Zelch. M. G. and Siege]. S. W.: Endourologic “sandwich” therapy for extensive staghorn calculi. J. Endourol., 1: 253, 1987.

EDITORIAL COMMENT

Staghorn calculi are at once dangerous stones whose successful treatment has been controversial during the years, and in which the consequences of failure loom large as infection persists and stones re-grow. In the modern era, the ease and ubiquity of ESWL resulted in many staghorn calculi being treated with repeated courses of ESWL when results were often not satisfactory. The authors address this issue in admirable fashion in a prospective randomized study and, as importantly, one performed a t a single center. The results are dramatic and the conclusion is undeniable that combined therapy is

superior in every respect to ESWL alone in this patient group. The authors note that the 22% success rate with ESWL was lower than what other reports have documented. The explanation for this find- ing is that these are, in fact, staghorn calculi in this group and not a group containing multiple caliceal stones or other stones of low volume.

Some would argue that open surgery should be considered as a treatment alternative, and while one would certainly agree that surgery always is an option, particularly when the stone is large and in an anatomically complicated setting, nevertheless most would agree that the morbidity, postoperative pain and discomfort attend- ing open stone surgery compared to less invasive measures mean that these measures should be preferred.

Joseph W. Segura Department of Urology Mayo Clinic Rochester, Minnesota