Metabolic evaluation and medical management of staghorn calculi

doi:10.1016/j.ajur.2019.12.007

Asian Journal of Urology, 2020, 7 (2): 122-129 doi: 10.1016/j.ajur.2019.12.007

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Metabolic evaluation and medical management of staghorn calculi

Russell S. Terry,Glenn M. Preminger(

)

Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA

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Abstract

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.

Key words： Urolithiasis Staghorn Metabolic evaluation Struvite

Received: 28 June 2019 Available online: 17 December 2019

Corresponding Authors: Glenn M. Preminger E-mail: glenn.preminger@duke.edu

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Russell S. Terry,Glenn M. Preminger. Metabolic evaluation and medical management of staghorn calculi[J]. Asian Journal of Urology, 2020, 7(2): 122-129.

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http://www.ajurology.com/EN/10.1016/j.ajur.2019.12.007 OR http://www.ajurology.com/EN/Y2020/V7/I2/122

Staghorn. (A) Skeleton of a stag moose, cervalces scotti, housed at the Royal Ontario Museum; (B) Plain abdominal X-ray depicting bilateral staghorn calculi.

Prior publications of staghorn calculus case series in which stone type is identified.

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