Staghorn renal stones: what the urologist needs to know

Abstract

Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are composed of struvite (magnesium ammonium phosphate) and are linked to urinary tract infection by urease-producing pathogens. Preoperative computed tomography scan and careful evaluation of all urine cultures made prior surgery are essential for a well-planning surgical approach and a right antibiotics choice. Gold standard surgical technique is the percutaneous nephrolithotomy (PCNL). In cases of impossible percutaneous renal access, anatrophic nephrolithotomy is an alternative. Shockwave lithotripsy and flexible ureteroscopy are useful tools to treat residual fragments that can be left after treatment of complete staghorn renal stone. PCNL can be performed in supine or prone position according to surgeon's experience. Tranexamic acid can be used to avoid bleeding. To check postoperative stone-free status, computed tomography is the most accurate imaging exam, but ultrasound combined to KUB is an option. Intra-operative high-resolution fluoroscopy and flexible nephroscopy have been described as an alternative for looking at residual fragments and save radiation exposure. The main goals of treatment are stone-free status, infection eradication, and recurrence prevention. Long-term or shortterm antibiotic therapy is recommended and regular control imaging exams and urine culture should be done.

Comparison of Vacuum-Assisted Sheath and Normal Sheath in Minimally Invasive Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

“…PCNL has been accepted as the gold standard for treatment of large sized renal stones and is widely used in clinical practice [3,20]. Although technological advances have ensured a lot of progress in this eld, many complications still exist [21].…”

“…The kidney stone prevalence rate worldwide is approximately 1.7-8.8% and it cost about $2.1 billion in 2020 alone [2]. Patients with nephrolithiasis often suffer from short-term complications such as acute renal colic, nausea, vomiting, and hematuria, and long-term complications such as chronic renal failure and hydronephrosis [3]. Therefore, treatment of calculi has always been the focus of surgeons.…”

Kidney Stone Disease With Special Regard to Drug-Induced Kidney Stones – A Contemporary Synopsis

“…In terms of the general location of urinary stones, these may be located inside the kidney (in the upper, middle or lower calyxes or in the renal pelvis) and/or in the urinary tract (in the upper, middle or distal urether, in the urinary bladder or the urethra) [3]. The special term "staghorn renal stones" refers to the massive kidney stones that fill the renal pelvis and at least one of the renal calyces [9]. The comparison of urinary stones depends on their chemical composition.…”

Effect of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition: A meta-analysis and systematic review

“…The worldwide kidney stone prevalence rate is 1.7% to 8.8% costs about $2.1 billion in 2020 [3,4]. Patients with nephrolithiasis often suffer from short-term complications such as acute renal colic, nausea, vomiting, and hematuria, and long-term complications such as chronic renal failure and hydronephrosis [5]. Furthermore, it is often associated with an incidence of recurrence after an initial event of 30% to 50% without prevention [6].…”