Conservative management of staghorn stones

Abstract

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.

Comparative assessment of multiple‐tract vs single‐tract percutaneous nephrolithotomy

“…Once more, this case emphasizes the importance of unbiased preoperative clinical judgment, whether active stone removing treatment or conservative treatmentif necessary secured by permanent percutaneous urinary drainagemight be a patient's most appropriate option. 30 Length of hospital stay was significantly longer in our multiple-tract group, which was mostly driven by the higher number of postoperative urinary drainages by nephrostomy tube. Cho et al, by reporting no difference in LOS in a multi-tract cohort of 30 patients, and two current feasibility studies investigating multiple-tract as a day surgery and an overnight surgery, point to the possibility that there is not necessarily the need for a longer LOS for patients with multiple-tract PNL.…”

“…However, one multiple‐tract PNL‐related death occurred on postoperative day 6 after refractory hemorrhage with futile radiologic embolization and cardiac arrest during induction of anesthesia for emergency nephrectomy in a 53‐year old female patient with a history of urolithiasis‐related urosepsis, adrenal insufficiency and multiple severe comorbidities (CCI = 9). Once more, this case emphasizes the importance of unbiased preoperative clinical judgment, whether active stone removing treatment or conservative treatment – if necessary secured by permanent percutaneous urinary drainage – might be a patient's most appropriate option 30 …”

A surfacing staghorn: Spontaneous expulsion of a large renal calculus from a nephrocutaneous fistula

“…A recent literature review found 10 studies (total of 304 patients) observing the outcomes of patients with staghorn stones managed conservatively. 9 They found that progressive renal deterioration occurred in a mean of 27.5% cases, with a higher rate among bilateral staghorn patients (44% vs. 9%). Dialysis was required in 9% of patients (20% bilateral, 41% unilateral).…”

Retrograde intrarenal surgery with intelligent control of renal pelvic pressure for staghorn calculi: a case report

“…The incidence of staghorn calculi is higher in women than that in men ( 13 ). It consists of struvite and is associated with recurrent urinary tract infection ( 14 ). Conservative treatment of staghorn calculi often leads to renal impairment and sepsis, with a mortality rate of 30% ( 15 ).…”