A retrospective study was done on 64 patients who received staged extracorporeal shock wave lithotripsy (ESWL) monotherapy for complete renal staghorn calculi. We used laboratory-proven stone components and a regular postoperative follow-up for a minimum of 6 months. There were 46 women and 18 men. The ages ranged from 19 to 75 years (mean 48.5 years). The number of ESWL sessions ranged from 1 to 4, with a mean of 2.1 sessions. The mean cumulative hospital stay was 13.3 days (range: 6-26 days). Successful treatments were defined as debulking over 90% of the stone burden and residual fragments of less than 3 mm in the longest diameter without obstruction 6 months post-treatment. A success rate of 86% was achieved in patients who had normal or minimal hydrocalycosis and only a 14.3% success rate for the patients with moderate to severe hydrocalycosis (p less than 0.005). Five of the patients with radiant calcium oxalate monohydrate had an unfavorable outcome. The best results were observed in the patient group of magnesium ammonium phosphate/apatite with normal to minimal hydrocalycosis (94.4% successful). The stone-free rate in this series was 51.6% at 6 months posttreatment. Being the least invasive, staged ESWL monotherapy is one of the better alternatives for the treatment of complete renal staghorn calculi in a select patient group.