Other non-surgical options are usually considered in combination with surgery or as monotherapy only if patients are surgically unfit. Percutaneous nephrolithotomy should be the recommended first-line treatment for staghorn stones. Generally, the gold standard treatment for staghorn stones is surgical with a view to achieve stone-free collecting system and preserve renal function. Staghorn stones are, therefore, significant disease entity that should be managed aggressively and effectively. Conversely, conservative treatment has been shown to carry a mortality rate of 28% in 10-year period and 36% risk of developing significant renal impairment. Due to the significant morbidity and potential mortality attributed to staghorn stones, prompt assessment and treatment is mandatory. Although kidney stones are commoner in men, staghorn stones are less often reported in men compared to women and they are usually unilateral. If left untreated, staghorn calculi result in chronic infection and eventually may progress to xanthogranulomatous pyelonephritis 5.Staghorn stones are large branching stones that fill part of all of the renal pelvis and renal calyces and they can be complete or partial depending on the level of occupancy of the collecting system. Staghorn calculi need to be treated surgically, usually PCNL (percutaneous nephrolithotomy) +/- ESWL (extracorporeal shockwave lithotripsy) and the entire stone removed, including small fragments, as otherwise, these residual fragments act as a reservoir for infection and recurrent stone formation. When viewed on bone windows they have a laminated appearance, due to alternating bands of magnesium ammonium phosphate and calcium phosphate 5. Staghorn calculi are radiopaque and conform to the renal pelvis and calyces, which are often to some degree dilated. The collecting system is filled with a densely calcified mass, producing marked posterior acoustic shadowing. The vast majority of staghorn calculi are radiopaque and appear as branching calcific densities overlying the renal outline and may mimic an excretory phase intravenous pyelogram. Uric acid and cystine are the underlying components of a minority of these calculi 5. Struvite accounts for approximately 70% of the composition of these calculi and is usually mixed with calcium phosphate thus rendering them radiopaque on both plain films and CT. Urease hydrolyzes urea to ammonium with an increase in the urinary pH 3-5. Proteus, Klebsiella, Pseudomonas and Enterobacter). Staghorn calculi are composed of struvite (chemically this is magnesium ammonium phosphate or MAP) and are usually seen in the setting of recurrent urinary tract infection with urease-producing bacteria (e.g. The majority of staghorn calculi are symptomatic, presenting with fever, hematuria, flank pain and potentially septicemia and abscess formation. Staghorn calculi are the result of recurrent infection and are thus more commonly encountered in women 6, those with renal tract anomalies, reflux, spinal cord injuries, neurogenic bladder or ileal ureteral diversion.
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