Extracorporeal shock wave lithotripsy as monotherapy for staghorn calculi--is reduced renal function a relative contraindication?

Extracorporeal shock wave lithotripsy as monotherapy for staghorn calculus is not without complications. We describe a case in which, due to markedly reduced renal function following lithotripsy for a staghorn calculus, broken fragments of calculi forming steinstrasse became cemented together to form a solid calcified tube extending from the renal pelvis to the ureteric orifice. This resulted in further loss of kidney function. The patient eventually required nephro-ureterectomy. Extreme care should be taken when using extracorporeal shock wave lithotripsy to treat staghorn calculi in kidneys with markedly diminished function to prevent further loss of function due to treatment.