Staghorn renal stones: a review
DOI:
https://doi.org/10.18203/2320-6012.ijrms20232482Keywords:
Renal lithiasis, Urology, Staghorn lithiasis, Lithiasis, Percutaneous nephrolithotomyAbstract
Staghorn lithiasis is described as the presence of stones in the urinary tract that create a mold of the renal collecting system, with the characteristic of being branched. It has a strong association with urinary tract infections caused by urea-splitting organisms. The composition of the stone usually consists of pure magnesium ammonium phosphate (struvite), or a mixture of struvite and calcium carbonate apatite. It is classified as complete and partial. In the complete one, the stones occupy the renal pelvis and the calyceal system, or more than 80% of the collecting system; unlike the partial ones that occupy the renal pelvis and at least two calyces. Computed tomography without intravenous contrast is the imaging method of choice for diagnosis and planning of surgical intervention. Allowing an accurate assessment of the morphology and location of the stones; that will set the standard for guiding percutaneous access. Complete stone cleaning is the cornerstone of staghorn lithiasis treatment. The guidelines of the European Association of Urology and the American Association of Urology mention that percutaneous nephrolithotomy continues to be the treatment of choice for large stones. Conservative management is related to renal loss and urosepsis, reporting a mortality of 28 % up to 30% within 10 years, as well as a 36% risk of developing chronic kidney disease.
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Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr; AUA Nephrolithiasis Guideline Panel. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005;173(6):1991-2000.
Keller EX, De Coninck V, Doizi S, Traxer O. The role of ureteroscopy for treatment of staghorn calculi: A systematic review. Asian J Urol. 2020;7(2):110-5.
Sharbaugh A, Morgan Nikonow T, Kunkel G, Semins MJ. Contemporary best practice in the management of staghorn calculi. Ther Adv Urol. 2019;11:1-9.
Heimbach D, Jacobs D, Müller SC, Hesse A. Chemolitholysis and lithotripsy of infectious urinary stones - an in vitro study. Urol Int. 2002;69(3):212-8.
Healy KA, Ogan K. Pathophysiology and management of infectious staghorn calculi. Urol Clin. 2007;34(3):363-74.
Torricelli FCM, Monga M. Staghorn renal stones: what the urologist needs to know. Int Braz J Urol. 2020;46(6):927-33.
Rieu P. Infective lithiasis. Ann Urol (Paris). 2005;39:16-29.
Diri A, Diri B. Management of staghorn renal stones. Ren Fail. 2018;40(1):357-62.
Bichler KH, Eipper E, Naber K. Urinary infection stones. Int J Antimicrob Agents. 2002;19:488-98.
Gadzhiev N, Malkhasyan V, Akopyan G, Petrov S, Jefferson F, Okhunov Z. Percutaneous nephrolithotomy for staghorn calculi: Troubleshooting and managing complications. Asian J Urol. 2020;7(2):139-48.
Marien T, Miller NL. Treatment of the Infected Stone. Urol Clin North Am. 2015;42(4):459-572.
Nakamon T, Kitirattrakarn P, Lojanapiwat B. Outcomes of percutaneous nephrolithotomy: comparison of elderly and younger patients. Int Braz J Urol. 2013;39:692-701.
Nakada SY, Hoff DG, Attai S, Heisey D, Blankenbaker D, Pozniak M. Determination of stone composition by noncontrast spiral computed tomography in the clinical setting. Urology. 2000;55(6):816-9.
Turk C, Skolarikos A, Neisius A, Petrik A, Seitz C, Thomas K. EAU guidelines on urolithiasis. Available at: https://uroweb.org/guidelines/urolithiasis. Accessed on 23 March 2023.
Gao X, Fang Z, Lu C, Shen R, Dong H, Sun Y. Management of staghorn stones in special situations. Asian J Urol. 2020;7(2):130-8.
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical Management of Stones: American Urological Association/ Endourological Society Guideline, PART I. J Urol. 2016;196(4):1153-60.
Chibber PJ. Percutaneous nephrolithotomy for large and staghorn calculi. J Endourol. 1993;7:293-5.
Klein I, Gutiérrez-Aceves J. Preoperative imaging in staghorn calculi, planning and decision making in management of staghorn calculi. Asian J Urol. 2020;7(2):87-93.
Ganpule AP, Naveen Kumar Reddy M, Sudharsan SB, Shah SB, Sabnis RB, Desai MR. Multitract percutaneous nephrolithotomy in staghorn calculus. Asian J Urol. 2020;7(2):94-101.
Netto NR Jr, Ikonomidis J, Ikari O, Claro JA. Comparative study of percutaneous access for staghorn calculi. Urology. 2005;65(4):659-62.
Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM. Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: A new standard for percutaneous nephrolithotomy? Eur Urol. 2008;54(6):1393-403.
Goktug HNG, Ozturk U, Cimen S, Kaymak S, Dogan AE, Imamoglu MA. Comparison of the Conventional PNL with Ecirs in the Treatment of Complete Staghorn Kidney Stones. J Coll Physicians Surg Pak. 2023;33(3):346-51.
Cohen J, Cohen S, Grasso M. Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int. 2013;111(3):E127-31.
Bernardo NO, Smith AD. Chemolysis of urinary calculi. Urol Clin North Am. 2000;27:355-65.
Winoker JS, Bamberger JN, Chandhoke RA, Atallah W, Gupta M. What Factors Drive Staghorn vs Nonstaghorn Pattern Growth in Patients with Metabolic Stones? J Endourol. 2019;33:954-9.
Gücük A, Kemahlı E, Üyetürk U, Tuygun C, Yıldız M, Metin A. Routine flexible nephroscopy for percutaneous nephrolithotomy for renal stones with low density: a prospective, randomized study. J Urol. 2013;190(1):144-8.
El-Nahas AR, Elshal AM, El-Tabey NA, El-Assmy AM, Shokeir AA. Percutaneous nephrolithotomy for staghorn stones: a randomised trial comparing high-power holmium laser versus ultrasonic lithotripsy. BJU Int. 2016;118(2):307-12.
Xiao Y, Li Q, Huang C, Wang P, Zhang J, Fu W. Perioperative and long-term results of retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for staghorn calculi: a single center randomized controlled trial. World J Urol. 2019;37(7):1441-7.
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