Staghorn renal stones: what the urologist needs to know.
Infections
Kidney
Urinary Calculi
Journal
International braz j urol : official journal of the Brazilian Society of Urology
ISSN: 1677-6119
Titre abrégé: Int Braz J Urol
Pays: Brazil
ID NLM: 101158091
Informations de publication
Date de publication:
Historique:
received:
10
02
2020
accepted:
25
03
2020
pubmed:
28
3
2020
medline:
28
1
2021
entrez:
28
3
2020
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 32213203
doi: 10.1590/S1677-5538.IBJU.2020.99.07
pii: IBJU20209907
pmc: PMC7527092
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
927-933Informations de copyright
Copyright® by the International Brazilian Journal of Urology.
Déclaration de conflit d'intérêts
None declared.
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