Management of staghorn stones in special situations

A huge staghorn renal stone: Is there still a need for open surgery to protect against further damage to the kidney? A case report

INTRODUCTION

Staghorn calculi (SC) occupy the renal pelvis and calyces and are common in females linked to repeated urinary tract infections (UTIs). Judicious surgery planning reduces the chance of further damage to the kidney due to renal SCs. Open stone surgery (OSS) is one of the various operative techniques to remove such huge stones with one operative intervention and protect the kidney from ongoing functional damage.

CASE REPORT

A 47-year-old male patient presented with right-sided renal colic pain, and on further investigations, he was diagnosed with a large renal stone responsible for substantial renal function impairment on the same side. The SC measured 8 × 4 cm with another stone in the lower calyx. thinner parenchyma, and only 16% relative function. Therefore, open surgery was selected over less invasive approaches because multiple lithotripsy (ESWL) sittings may have been required in less invasive options.

DISCUSSION

SCs, which can be complete or partial, often result in renal impairment. Hence, it is crucial to implement a proactive therapeutic approach that includes a thorough evaluation of the stone's size and position, the patient's choice, and institutional capacity. Complete elimination of SCs is preferred to maintain maximal renal function. Based on clinical, technical, and socioeconomic considerations, open pyelolithotomy or OSS was chosen over percutaneous nephrolithotomy for SC removal in the discussed case.

CONCLUSION

The ability to remove large stones in a single intervention with open pyelolithotomy has been very effective due to its distinctive clinical presentation and pathological abnormalities.

A silent giant staghorn renal calculus managed successfully with open pyelolithotomy: a case report

Staghorn calculi (SC) are associated with high morbidity and mortality; therefore, meticulous planning is required to minimize complications. In this case report, we will discuss the management of a giant right-sided SC (~ 8 cm in diameter), which was incidentally found in a 40-year-old male, who presented with left-sided renal colic symptoms with no associated renal impairment. This case was further complicated by multiple smaller calculi surrounding the giant SC. Hence, open surgery was preferred to minimally invasive techniques. The patient underwent an uncomplicated right-sided open pyelolithotomy for his staghorn calculus and was calculi free at 1-month follow-up. His renal function returned to normal levels, highlighting effective management of the stones.

Retroperitoneal abscess caused by dropped renal stones

Staghorn calculi account for about 4% of presenting renal stones in developed countries, are source of recurrent urinary tract infection, and may be eventually treated by surgical stone removal. A 55-year-old female with a history of staghorn renal calculi and recurrent urinary tract infections presented with a left flank and lower abdominal pain following recent left robotic partial nephrectomy and nephrolithotomy. Contrast-enhanced computed tomography (CT) of the abdomen demonstrated a large left-sided retroperitoneal fluid collection with a few dropped renal stones in the dependent portion of the collection. The patient treated with early percutaneous drainage of the collection and antibiotic treatment and responded well clinically. The clinical and imaging presentation of a rare case of retroperitoneal abscess formation caused by dropped renal stones is described in this study. Imaging, particularly ultrasound and CT, plays a key role in detecting the dropped renal stones and can help with differential diagnosis and treatment plans.

Providing Several Skills to Treat Complex Infectious Stones of Solitary Kidney in a Patient Failed to Undergo Percutaneous Nephrolithotomy: A Case Report

Conservative treatment is closely associated with renal deterioration for patients with renal staghorn stones. It is well-recognized that percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment of renal stones larger than 2 cm due to its higher stone clearance and cost-effectiveness when compared with other treatment alternatives, such as shockwave lithotripsy and flexible ureteroscopy (FURS). Besides, our findings indicated that miniaturized PCNL could be served as an alternative to PCNL with a higher stone-free rate and a lower hemorrhage risk. Despite the higher cost-effectiveness of PCNL, the management of staghorn stones are still controversial in some special situations, such as a solitary kidney. Herein, we present a case with complex infectious stones of a right-sided solitary kidney, complaining of persistent pain in the right waist. The rarity of this case is that it is difficult to encounter these cotton-like staghorn stones which are clinically resistant to holmium laser lithotripsy, and the particularity is that the patient with solitary kidney failed to undergo PCNL. We found that the combination of intermittently high-frequency oscillation and flexible ureteroscopy forceps might contribute to treat the complex infectious stones in a patient with solitary kidney. Our surgical experience might be beneficial to such patients undergoing flexible ureteroscopy in clinical practice.