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Journal of Surgical Case Reports Nov 2022A bifid ureter is an atypical anatomical variation that occurs with an incidence of 1-10%. This anomaly is in a continuum of duplex collecting systems and most commonly...
A bifid ureter is an atypical anatomical variation that occurs with an incidence of 1-10%. This anomaly is in a continuum of duplex collecting systems and most commonly involves a common distal ureter. This is usually asymptomatic and is predominantly an incidental diagnosis, nevertheless, is a potential risk factor for urolithiasis formation. Current surgical management of larger staghorn calculi favours percutaneous nephrolithotomy (PCNL) over traditional open surgery, however for multiple calculi and complex anatomy PCNL would require multiple punctures, with increased risk of bleeding, pleural injury, sepsis and ultimately failed stone clearance. We describe the case of a 71-year-old female with multiple calculi in bifid anatomy. A single open approach, aided with cold-ischaemia was successfully utilized in this context.
PubMed: 36452279
DOI: 10.1093/jscr/rjac547 -
Annals of the Royal College of Surgeons... Apr 2020Since the seminal works by Singh and Blandy in the 1970s, the management of staghorn stones has almost exclusively involved surgical intervention. In contrast, a more...
INTRODUCTION
Since the seminal works by Singh and Blandy in the 1970s, the management of staghorn stones has almost exclusively involved surgical intervention. In contrast, a more recent study found that conservative management was not as unsafe as previously believed. The present review sought to examine the available literature to understand the implications of a conservative strategy.
METHODS
A systematic search of the literature was carried out using MEDLINE, Embase™ and the Cochrane Central Register of Controlled Trials. All papers looking at management of staghorn calculi were reviewed and studies with a conservative management arm were identified. Outcomes of interest were recurrent or severe urinary tract infections, progressive renal deterioration, dialysis requirements, morbidity and disease specific mortality. Owing to the lack of relevant data, a descriptive review was carried out.
RESULTS
Our literature search yielded 10 suitable studies involving a total of 304 patients with staghorn stones managed conservatively. Progressive renal deterioration occurred in 0-100% of cases (mean 27.5%) with a higher rate among bilateral staghorn sufferers (44% vs 9%). Dialysis was required in 9% of patients (20% bilateral, 6% unilateral). The mean rate of severe infection was 8.7% and recurrent urinary tract infections occurred in as high as 50% of cases (80% bilateral, 41% unilateral). Disease specific mortality ranged from 0% to 67% (mean 20.5%).
CONCLUSIONS
It appears that conservative management of staghorn calculi is not as unsafe as previously thought and selection of patients with unilateral asymptomatic stones with minimal infection should be considered.
Topics: Conservative Treatment; Humans; Renal Dialysis; Renal Insufficiency; Severity of Illness Index; Staghorn Calculi; Urinary Tract Infections
PubMed: 31918554
DOI: 10.1308/rcsann.2019.0176 -
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 -
Translational Andrology and Urology Dec 2018Percutaneous nephrolithotomy (PCNL) is considered the treatment of choice for large urinary calculi and staghorn lithiasis. The approach for this surgery may be either... (Review)
Review
Percutaneous nephrolithotomy (PCNL) is considered the treatment of choice for large urinary calculi and staghorn lithiasis. The approach for this surgery may be either supine or prone, and different access techniques are described in the literature with the use of ultrasound, fluoroscopy, or both combined. We believe that prone PCNL offers to the urologist key advantages, such as the possibility of puncturing anatomically abnormal urinary tracts, to perform multiple percutaneous tracts in the same kidney, experiencing the vacuum cleaner effect, ease of exploring the upper calyx through the inferior calyx, possibility to perform endoscopic combined intrarenal surgery (ECIRS) and bilateral simultaneous surgery, and to performed over local anesthesia. An adequate training for the endourologist should include both the prone and supine techniques for PCNL and to know which patient can benefit the most from each one.
PubMed: 30505733
DOI: 10.21037/tau.2018.10.04 -
Asian Journal of Urology Apr 2020
PubMed: 32257798
DOI: 10.1016/j.ajur.2019.12.015 -
International Braz J Urol : Official... 2020Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we... (Review)
Review
Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are composed of struvite (magnesium ammonium phosphate) and are linked to urinary tract infection by urease-producing pathogens. Preoperative computed tomography scan and careful evaluation of all urine cultures made prior surgery are essential for a well-planning surgical approach and a right antibiotics choice. Gold standard surgical technique is the percutaneous nephrolithotomy (PCNL). In cases of impossible percutaneous renal access, anatrophic nephrolithotomy is an alternative. Shockwave lithotripsy and flexible ureteroscopy are useful tools to treat residual fragments that can be left after treatment of complete staghorn renal stone. PCNL can be performed in supine or prone position according to surgeon's experience. Tranexamic acid can be used to avoid bleeding. To check postoperative stone-free status, computed tomography is the most accurate imaging exam, but ultrasound combined to KUB is an option. Intra-operative high-resolution fluoroscopy and flexible nephroscopy have been described as an alternative for looking at residual fragments and save radiation exposure. The main goals of treatment are stone-free status, infection eradication, and recurrence prevention. Long-term or short-term antibiotic therapy is recommended and regular control imaging exams and urine culture should be done.
Topics: Female; Humans; Kidney; Male; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Staghorn Calculi; Treatment Outcome; Urologists
PubMed: 32213203
DOI: 10.1590/S1677-5538.IBJU.2020.99.07 -
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 -
American Journal of Clinical and... 2022For urologists, treating staghorn stones remains a difficult challenge. Various studies have evaluated the results of percutaneous nephrolithotomy (PCNL) and open...
BACKGROUND
For urologists, treating staghorn stones remains a difficult challenge. Various studies have evaluated the results of percutaneous nephrolithotomy (PCNL) and open surgery in different populations but these results were controversial. Here, we aimed to compare and evaluate the results of open surgery and PCNL in the treatment of staghorn stones.
METHODS
This retrospective descriptive study was performed to compare the results of open surgery and PCNL in the treatment of staghorn stones in 2013-2021. A total of 360 participants were studied among the population. Demographic data of patients including age, gender, and comorbidities were obtained. We assessed variables including type of stone, serum creatinine, degree of hydronephrosis, and urine culture before the operation. All participants in our study were informed of the two surgical alternatives.
RESULTS
The mean length of hospital stay in PCNL patients was 3.88 ± 1.76 and in open surgery patients was 5.858 ± 2.12 (P = 0.003). In 30 patients (13.9%) in the PCNL group and 27 patients (18.8%) in the open surgery group, bleeding necessitating blood transfusion was the only intraoperative complication. 309 patients (85%) had no residual stones at the time of discharge from the hospital, which was 81.9% (177 cases) in patients treated with PCNL and 91.6% (132 patients) in the open surgery group (P > 0.05).
CONCLUSION
Staghorn calculi can be managed effectively with open surgery or PCNL. Given the reduced postoperative complication rate and higher stone-free rate, we believe open surgery is better technique for complicated staghorn stones with a high burden.
PubMed: 36051615
DOI: No ID Found -
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 Jan 2021: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. : The data of consecutive adult patients who...
: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. : The data of consecutive adult patients who underwent PCNL for the treatment of staghorn stones, between July 2015 and December 2019 from three hospitals, were retrospectively reviewed. All cases were performed in a prone position under fluoroscopic guidance. The nephrostomy tracts were dilatated to 30 F in standard-PCNL and to 18-20 F in mini-PCNL. Stones were fragmented with pneumatic lithotripsy in both groups. Fragments were removed with forceps in the standard-PCNL, while they were evacuated through the sheath using the vacuum clearance effect in mini-PCNL. A ureteric stent was inserted after mini-PCNL, while a nephrostomy tube was inserted after standard-PCNL. : The study included 153 patients; 70 underwent standard-PCNL and 83 underwent mini-PCNL. The stone-free rates of PCNL monotherapy were comparable for both groups (83% for mini-PCNL and 88.6% for standard-PCNL, = 0.339). The incidence (12% vs 24.3%, = 0.048) and severity of complications were significantly lesser with mini-PCNL ( = 0.031). Standard-PCNL was associated with increased rate of blood transfusion (12.9% vs 2.4%, = 0.013) and a significant decrease in haemoglobin ( = 0.018). Hospital stay was significantly longer for standard-PCNL than mini-PCNL (median stay of 6 vs 3 days, 0.001). : The efficacy of mini-PCNL was comparable to standard-PCNL in the treatment of staghorn stones. The advantages of mini-PCNL included a lesser incidence and severity of complications, and shorter hospital stay.
PubMed: 34104489
DOI: 10.1080/2090598X.2021.1878670