Tratamiento de la litiasis coraliforme con Litroticia extracorpórea por ondas de choque. Análisis de nuestra serie en 20 años

Objective: To evaluate the effectiveness and complications of treatment with extracorporeal shock wave lithotripsy (ESWL) for staghorn stones. Design: A retrospective observational study on staghorn stones treated with ESWL at the Hospital Regional Universitario de Málaga, between 1990 and 2010. Results: The study included 157 patients (136 women and 21 men) that underwent ESWL for staghorn stones. Mean number of sessions for fragmentation was 3.39± 1.94, mean number of waves was 10,066.67±6,182.96, mean intensity was 16.24±12.37, mean accumulated energy was 402.69±182.07, and mean resolution time was 7.59±7.97 months. Of the patients analyzed, 106 were stone-free and 51 had small residual fragments. Only 12 patients had stone recurrence. The mortality rate was 0%. Ten percent of the patients had type IIIb Clavien-Dindo complications, 18% had type IIIa, and 3.31% had type II. The effectiveness quotient (Clayman et al.) was 0.49, if needing more than one session was considered retreatment, and 0.71, if all sessions were considered a single treatment. Study limitations: Given the retrospective, observational study design, the conclusions were relative, due to the heterogeneity between patients regarding urinary tract morphology, stone size, and stone composition. Originality or value: ESWL in patients with multiple comorbidities is an alternative to surgery. Conclusions: Even though ESWL is not the treatment of choice for staghorn stones, it is a valid option in selected cases, depending on availability at the center and/or experience of the urologist.