Staghorn calculi are
complex renal stones that occupy the majority of the renal collecting system
. These stones are associated with high morbidity and can lead to recurrent urinary tract infections, urosepsis, renal deterioration, and death if left untreated. Managing patients with staghorn calculi can be challenging.
What causes staghorn calculus?
Staghorn stones form in the renal pelvis. Some of the risk factors for staghorn stone formation include
long standing history of stones
, certain unique metabolic defects, and repeated urinary tract infections with particular types of bacteria.
What is the most common cause of staghorn renal calculi?
Epidemiology. 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.
What are the symptoms of a staghorn kidney stone?
Symptoms may include
flank pain classic for renal colic, fever, urinary symptoms (eg, frequency, dysuria), and hematuria (either gross or microscopic)
. However, struvite stones rarely manifest as a solitary ureteral stone with acute renal colic in the absence of prior intervention.
Do staghorn calculi cause pain?
Symptoms of Kidney Stones
Struvite and staghorn kidney stone symptoms are similar to those of regular kidney stones. A few symptoms of these kidney stones are:
Painful urination
.
How do you treat staghorn calculus?
Generally, the gold standard treatment for staghorn stones is
surgical with
a view to achieve stone-free collecting system and preserve renal function. Percutaneous nephrolithotomy should be the recommended first-line treatment for staghorn stones.
Can you live with a staghorn kidney stone?
Due to the significant morbidity and potential mortality attributed to staghorn stones, prompt assessment and treatment is mandatory. Conversely, conservative treatment has been shown to carry a mortality rate of 28
% in
10-year period and 36% risk of developing significant renal impairment.
What does staghorn calculi look like?
Staghorn calculi, also sometimes called coral calculi, are renal calculi that obtain their characteristic shape by forming a cast of the renal pelvis and calyces, thus
resembling the horns of a stag
.
How big can a staghorn calculus get?
Urinary tract calculi (i.e., “liths” or stones) may vary in size from
less than 1 mm to several centimeters
(“staghorn” calculi) and are typically seen as round, oval, or polygonal foci of high radiodensity within the renal parenchyma (Fig. 20-8), collecting system, ureter, or bladder.
How are staghorn kidney stones removed?
In
percutaneous nephrolithotomy or nephrolithotripsy
, the surgeon makes a small incision in your back to remove kidney stones. He or she then puts a hollow tube into your kidney and a probe through the tube. In nephrolithotomy, the surgeon removes the stone through the tube.
What problems are possible as a result of the staghorn stone?
If left untreated, staghorn calculi will destroy the kidney and may cause the death of the patient. Complications include
azotemia, hydropyonephrosis, perinephric abscess, pyelonephritis (severe or end-stage), sepsis, and xanthogranulomatous pyelonephritis
.
What size of kidney stones need surgery?
The larger a stone is, the less likely that it will pass without surgery. Surgical treatment is usually recommended for stones
0.5 centimeters in size and larger
, as well as for patients who fail conservative management.
What foods make kidney stones worse?
Avoid stone-forming foods:
Beets, chocolate, spinach, rhubarb, tea, and most nuts
are rich in oxalate, which can contribute to kidney stones. If you suffer from stones, your doctor may advise you to avoid these foods or to consume them in smaller amounts.
What are staghorn calculi normally composed of?
Most staghorn calculi are infection stones composed of
struvite and/or carbonate apatite
. Sometimes, cystine, uric acid, whewellite and brushite stones also assume a staghorn configuration when located in the kidney. It is very important in stone crushing to know the composition and architecture of the stones.
What organism causes staghorn kidney stones?
E. coli
was the most common bacteria grown from the stones, and was isolated in 50% of the cases; Ureaplasma urealyticum was the most common organism causing UTI, grown in 62.5% of the urine samples. There was a high concordance rate between bacteria in the stones and urine.
Is nephrolithiasis a disease?
Nephrolithiasis, or
kidney stone disease
, is a condition in which individuals form calculi (stones) within the renal pelvis and tubular lumens. Stones form from crystals that precipitate (separate) out of the urine.
