Open stone surgery: is it still a preferable procedure in the management of staghorn calculi?

We reviewed 43 patients with staghorn calculi to determine the effectiveness of various treatment modalities such as extracorporeal shock wave lithotripsy (ESWL) monotherapy, ESWL and percutaneous nephrolithotomy (PCNL) combined therapy, and open stone surgery. While ESWL monotherapy and ESWL+PCNL were performed in 25 and 8 patients, respectively, 10 patients underwent open stone surgery. Of the 25 patients treated with ESWL, 8 were stone-free, whereas 4 out of 8 patients treated with ESWL+PCNL and 8 out of 10 patients treated with open surgery were stone-free. The complications of ESWL monotherapy consisted of pyelonephritis in one patient, and stone street formation in three. In the group of ESWL+PCNL, one patient developed pyonephrosis, and another perinephritic abscess. No serious complication was noted in patients who underwent open surgery, but an average of 525 ml of blood transfusion was required. We conclude that open stone surgery, although invasive, is still beneficial in the treatment of staghorn calculi.