![]() ![]() Incidentally, since an asymptomatic status may help guide shared It is essential to know whether the stone was discovered Presence of previous bladder infections, pyelonephritis, hematuria, or pain areĬlinically important. Symptoms, evolution of discovery, and current condition of the patient. Thorough history of present illness is the first step to determine the onset of Imperative when evaluating patients presenting with kidney stone disease. Obtaining a thorough and complete history and performing a physical exam is Urologist navigate this complex condition. Treatment, and follow up of patients with staghorn calculi to help the practicing We aim to describe the contemporary best practices in the initial evaluation, Our knowledge of metabolicĭisturbances, stone compositions, and overall natural history of the disease has Our developing understanding of this disease process. Traditional thinking about the management of this condition and stems partly from Some select candidates, especially those at high risk for surgery. We have evolved also by considering conservative management in Though there is undeniable progress, we have not been able 10 These advancements assist providers in achieving more effective stone removalĪnd better patient care. Intra- and extracorporeal lithotripsy technology. New technology continues to drive us toĪn operating room table with high definition, superior endoscopes and advanced Led to safer and more effective treatments. Science, and the field of endourology have continued to evolve and advancements have Rates up to 50%, including sepsis, bleeding, cardiothoracic events, and even While surgical treatment of these stones is the standard of care in many patients,Įarly series on treatments such as percutaneous nephrolithotomy quote complication However, achieving a stone-free state can beĭifficult, requiring staged or combined approaches. 7 The treatment goal for most patients is complete stone removal to prevent 6 These stones are still often associated with infection and urea-splitting organisms. Historically thought to be primarily struvite, but modern investigations reveal theyĬan be one of many compositions. Urosepsis, renal deterioration, and death. Given that untreated stones can lead to recurrent urinary tract infections, Treatment is often complicated but necessary If left untreated, staghorn calculi result in chronic infection and eventually may progress to xanthogranulomatous pyelonephritis 5.Staghorn calculi are complex renal stones that occupy the majority of the renalĬollecting system and are of particular importance to urologists as they often carry Staghorn calculi need to be treated surgically, usually PCNL (percutaneous nephrolithotomy) +/- ESWL (extracorporeal shockwave lithotripsy) and the entire stone removed, including small fragments, as otherwise, these residual fragments act as a reservoir for infection and recurrent stone formation. When viewed on bone windows they have a laminated appearance, due to alternating bands of magnesium ammonium phosphate and calcium phosphate 5. Staghorn calculi are radiopaque and conform to the renal pelvis and calyces, which are often to some degree dilated. The collecting system is filled with a densely calcified mass, producing marked posterior acoustic shadowing. The vast majority of staghorn calculi are radiopaque and appear as branching calcific densities overlying the renal outline and may mimic an excretory phase intravenous pyelogram. Uric acid and cystine are the underlying components of a minority of these calculi 5. Struvite accounts for approximately 70% of the composition of these calculi and is usually mixed with calcium phosphate thus rendering them radiopaque on both plain films and CT. Urease hydrolyzes urea to ammonium with an increase in the urinary pH 3-5. Proteus, Klebsiella, Pseudomonas and Enterobacter). Staghorn calculi are composed of struvite (chemically this is magnesium ammonium phosphate or MAP) and are usually seen in the setting of recurrent urinary tract infection with urease-producing bacteria (e.g. The majority of staghorn calculi are symptomatic, presenting with fever, hematuria, flank pain and potentially septicemia and abscess formation. Staghorn calculi are the result of recurrent infection and are thus more commonly encountered in women 6, those with renal tract anomalies, reflux, spinal cord injuries, neurogenic bladder or ileal ureteral diversion. ![]()
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