Conservative management of staghorn calculi: a single‐centre experience

Abstract

ObjectiveTo evaluate the outcomes of conservatively managed staghorn calculi, specifically looking at morbidity and mortality, incidence of infections and progressive changes in renal function. Patients and MethodsA total of 22 patients with unilateral or bilateral staghorn calculi, who were treated conservatively, were included in the study. Patients were reviewed yearly with symptom assessment, urine culture and measurement of estimated glomerular filtration rate. ResultsThe presentations to the urology department of staghorn calculi were incidental (41%), haematuria (36%), abdominal discomfort (5%) and recurrent urinary tract infections (UTIs; 18%). The reasons for conservative management in the cohort were comorbidities (59%), patient choice (36%) or poor access/anatomy (5%). In the whole cohort the rate of recurrent UTIs was 50%, the progressive renal failure rate was 14%, the disease-specific mortality rate was 9%, the dialysis dependence rate was 9% and the rate of hospital attendances attributable to stone-related morbidity was 27%. Comparison of outcome measures between the unilateral and bilateral staghorn stones showed statistically significant differences in disease-specific mortality (0 vs 40%) and morbidity (12 vs 80%) in favour of the unilateral group. Although there was a lower incidence of UTIs (41 vs 80%), renal deterioration (6 vs 40%) and dialysis requirement (6 vs 20%) in the unilateral group, these findings were not statistically significant. ConclusionsFrom the results, we conclude that conservative management of staghorn calculi is not as unsafe as previously thought. Careful patient selection to include unilateral asymptomatic stones with minimal infection, and thorough counselling with regard to the risks, could make conservative management a suitable option for specific patient groups.

Current insights into the mechanisms and management of infection stones

“…Complications associated with the development of kidney stones include pyonephrosis, perinephric abscess formation, and xanthogranulomatous pyelonephritis, which can lead to renal failure, potential loss of the kidney, and even death in some patients 33,34 . Early reports suggested that untreated staghorn stone formers had a 50% chance of losing one kidney 35 ; however, subsequent studies have shown that ~14% of patients undergoing conservative management of staghorn calculi had progressive renal failure, and 9% of the patients required dialysis owing to the deterioration of renal function 36 .…”

Management of staghorn renal stones

“…However in a recent study, Deutsch and Subramonian [ 21 ] showed that conservative management of staghorn calculi, in the context of patients who are unfit for surgery or who decline intervention, can be a suitable option. They also concluded that conservative management of staghorn calculi is not as unsafe as previously thought.…”

Clinical Outcomes of Retrograde Intrarenal Surgery as a Primary Treatment for Staghorn Calculi: A Single-Center Experience

“…1 A newly diagnosed staghorn calculi represents a standard indication for active management. 2,3 The American Urological Association and European Association of Urology guidelines recommend that staghorn calculi should be treated primarily with percutaneous nephrolithotomy (PCNL). 1,4 Although the efficacy of PCNL is well-established, serious complications can occur, such as massive hemorrhage or injury to surrounding organs.…”