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The Urologic Clinics of North America Feb 1997Struvite staghorn calculi are infected stones that represent a real threat to the kidney and to the patient and are an indication for active treatment in most... (Review)
Review
Struvite staghorn calculi are infected stones that represent a real threat to the kidney and to the patient and are an indication for active treatment in most individuals. SWL, PL, combined PL and SWI, and open surgery are all viable treatment options for these patients. Most patients should be treated with combined therapy, reserving SWL for small-volume stones and open surgery for difficult situations that do not lend themselves to combined treatment.
Topics: Clinical Protocols; Combined Modality Therapy; Humans; Kidney Calculi; Kidney Calices; Lithotripsy; Nephrostomy, Percutaneous; Radiography
PubMed: 9048853
DOI: 10.1016/s0094-0143(05)70355-4 -
Asian Journal of Urology Apr 2020Staghorn renal calculi are large renal calculi that occupy nearly the entirety of the renal collecting system. They may be composed of metabolic or infection stone... (Review)
Review
Staghorn renal calculi are large renal calculi that occupy nearly the entirety of the renal collecting system. They may be composed of metabolic or infection stone types. They are often associated with specific metabolic defects. Infection stones are associated with urease-producing bacterial urinary tract infections. The ideal treatment for staghorn calculi is maximal surgical removal. However, some patients are either unwilling or unable to proceed with that modality of treatment, and therefore other management must be used. One such technique is the metabolic evaluation with directed medical management. Based on contemporary evidence that the majority of staghorn stones are metabolic in etiology, and furthermore that even infection stones are usually associated with metabolic abnormalities, metabolic evaluation with directed medical management is recommended for all staghorn stone formers. The scientific basis of this recommendation is reviewed in the present work.
PubMed: 32257805
DOI: 10.1016/j.ajur.2019.12.007 -
Asian Journal of Urology Apr 2020Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn stones.... (Review)
Review
Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despite continuous refinements to the technique and instrumentation of PCNL, these stones remain a troublesome challenge for endourologists and are associated with a higher rate of perioperative complications than that for non-staghorn stones. Common and notable intraoperative complications include bleeding, renal collecting system injury, injury of visceral organs, pulmonary complications, thromboembolic complications, extrarenal stone migration, and misplacement of the nephrostomy tube. Postoperative complications include infection and urosepsis, bleeding, persistent nephrocutaneous urine leakage, infundibular stenosis, and death. In this review, we report recommendations regarding troubleshooting measures that can be used to identify and characterize these complications. Additionally, we include information regarding management strategies for complications associated with PCNL for staghorn calculi.
PubMed: 32257807
DOI: 10.1016/j.ajur.2019.10.004 -
Asian Journal of Urology Apr 2020
PubMed: 32257798
DOI: 10.1016/j.ajur.2019.12.015 -
Asian Journal of Urology Apr 2020To define the role of ureteroscopy for treatment of staghorn calculi. (Review)
Review
OBJECTIVE
To define the role of ureteroscopy for treatment of staghorn calculi.
METHODS
A systematic review was conducted using the Scopus and Medline databases. Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.
RESULTS
In five studies on ureteroscopic monotherapy, stone-free rate (SFR) ranged from 33% to 93%, with a maximum four ureteroscopy sessions per patient and no major complications. Endoscopic combined intrarenal surgery (ECIRS) was compared with percutaneous nephrolithotomy (PNL) in two studies and reached significantly higher SFR (88%-91% 59%-65%) and lower operative times (84-110 min 105-129 min). The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%-89%. One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi, with a SFR of 92%.
CONCLUSION
Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi. Ureteroscopy is also particularly suitable for clearance of residual stones. In specific cases, ureteroscopy may become the sole applicable therapeutic option to staghorn calculi. Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.
PubMed: 32257803
DOI: 10.1016/j.ajur.2019.10.012 -
Asian Journal of Urology Apr 2020Staghorn calculi present a particular and challenging entity of stone morphology. Treatment is associated with lower stone-free rates and higher complication rates... (Review)
Review
OBJECTIVE
Staghorn calculi present a particular and challenging entity of stone morphology. Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones. In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition.
METHODS
We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones. Non-contrast computerized tomography (NCCT) is indeed the standard imaging tool for percutaneous nephrolithotomy (PCNL); additional tools such as three-dimensional computed tomography (CT) reconstruction of the staghorn calculus may help plan access in complex cases. Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus. Wideband doppler ultrasound and real-time virtual sonography can assist. New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported, but have not shown utilization in staghorn cases. Staghorn morphometry-based prediction algorithms may predict the number of tract(s) and stage(s) for PCNL monotherapy. Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones, with significantly less complications rate; Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density (STONE) nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases. There is a growing trend of endoscopic combined intrarenal surgery (ECIRS) in concordance with PCNL to treat larger stones. Conservative management of staghorn calculi is an undesired option, but can be an alternative for a carefully selected group of high-risk patients.
CONCLUSION
Staghorn stones may lead to deterioration of renal function and life-threatening urosepsis. This entity should be managed aggressively with planning ahead for surgery using the different tools available as the cornerstone for a successful outcome.
PubMed: 32257800
DOI: 10.1016/j.ajur.2019.07.002 -
Therapeutic Advances in Urology 2019Staghorn 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... (Review)
Review
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. Fortunately, advances in technology and endourology techniques have enabled urologists to effectively treat these stones with minimal morbidity to the patient. This article describes the contemporary best practices in the initial evaluation, management, and follow up of patients with staghorn calculi to help the practicing urologist navigate this complex condition.
PubMed: 35173810
DOI: 10.1177/1756287219847099 -
Asian Journal of Urology Apr 2020Due to their large size, rapid growth, and attendant morbidity, staghorn calculi are complex clinical entities that impose significant treatment-related challenges.... (Review)
Review
Due to their large size, rapid growth, and attendant morbidity, staghorn calculi are complex clinical entities that impose significant treatment-related challenges. Moreover, their relative heterogeneity-in terms of both total stone burden and anatomic distribution-limits the ability to standardize their characterization and the reporting of surgical outcomes. Several morphometry systems currently exist to define the volumetric distribution of renal stones, in general, and to predict the outcomes of percutaneous nephrolithotomy; however, they fall short in their applicability to staghorn stones. In this review, we aim to discuss the clinical utility of morphometry systems and the influence of pelvicalyceal anatomy on the management of these complex calculi.
PubMed: 32257799
DOI: 10.1016/j.ajur.2019.06.001 -
Arab Journal of Urology Sep 2012To review reports focusing on the surgical treatment of staghorn stones in children, as despite all the improvements in the surgical treatment of paediatric urolithiasis... (Review)
Review
OBJECTIVES
To review reports focusing on the surgical treatment of staghorn stones in children, as despite all the improvements in the surgical treatment of paediatric urolithiasis the management of staghorn calculi still represents a challenging problem in urology practice.
METHODS
To evaluate current knowledge about treating staghorn calculi in children, we searched PubMed for relevant articles published between 1991 and 2011, using a combination of related keywords, i.e. staghorn stone, child, kidney calculi, surgical treatment, electrohydraulic shockwave therapy (ESWL), percutaneous nephrolithotomy (PCNL), and open surgery. Reports relating to the treatment of paediatric stone disease in general (open surgery, PCNL, ESWL) were also searched with the same method. Additional references were obtained from the reference list of full-text reports.
RESULTS
Although open surgery had been widely used in the past for treating such stones in children, currently it has only limited indications in highly selected patients. Current published data clearly indicate that, in experienced hands, both PCNL and ESWL are now effective methods for treating staghorn calculi in children.
CONCLUSIONS
Due to advanced techniques and instrumentation, it is now possible to successfully treat staghorn calculi in children, with very limited safety concerns. Currently, while PCNL is recommended as the first-line surgical treatment, ESWL, open surgery and/or combined methods are valuable but secondary options in the treatment of paediatric staghorn calculi.
PubMed: 26558045
DOI: 10.1016/j.aju.2012.03.005 -
Journal of Medical Imaging and... Oct 2018
Review
Topics: Humans; Kidney Pelvis; Staghorn Calculi; Tomography, X-Ray Computed
PubMed: 30309062
DOI: 10.1111/1754-9485.54_12784