We present our experience with an endourologic "sandwich" protocol for treating patients with extensive staghorn calculi. The procedure involves primary percutaneous debulking, ESWL of inaccessible extensions of the stone, and secondary percutaneous extraction to hasten clearance of residual fragments. Although the overall results suggest that this regimen is safe and effective, commitment to a stone-free renal unit may necessitate additional procedures and extended hospitalization in some patients.
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Streem et al. (1987) studied this question.
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