Summary - Salute per tutti

Glenn M. PremingerPNL to SWL for staghorn stone management demonstratedstone-free rates with initial PNL to be more thanthree times greater than with SWL monotherapy. Themainstay of any form or combination or multi-modaltherapy should be endoscopic removal. This approachallows removal of a high volume of stone as well as anaccurate assessment of stone-free status. SWL may beutilized in cases where remaining stones cannot bereached with flexible nephroscopy or safely approachedvia another access tract. However, total removal of fragmentsfrom the collecting system after SWL without subsequentnephroscopy is unlikely. Extremely low stonefreerates have been reported for combination approacheswhere SWL was the last combination procedure.Therefore, percutaneous nephroscopy should be the lastpart of a combination therapy sequence as it allows forbetter assessment of stone-free status and a greaterchance of achieving this state.REFERENCES1. Meretyk S, Gofrit ON, Gafni O, et al. Complete staghorn calculi:Random prospective comparison between extracorporeal shockwave lithotripsy monotherapy and combined with percutaneousnephrostolithotomy. J Urol 1997; 157:780-786.2. Preminger GM, Assimos DG, Lingeman JE, et al. Chapter 1:AUA guideline on management of staghorn calculi: Diagnosis andtreatment recommendations. J Uro 2005; 173:1991-2000.3. Hegarty NJ, Desai MM. Percutaneous nephrolithotomy requiringmultiple tracts: comparison of morbidity with single-tract procedures.J Endourol 2006; 20:753-60.CorrespondenceGlenn M. Preminger, MDDepartment of Urologic SurgeryDUMC Box 3167, Room 1572D, White ZoneDuke University Medical CenterDurham, North Carolina 27710, USAglenn.preminger@duke.edu40Archivio Italiano di Urologia e Andrologia 2010; 82, 1