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Metabolic evaluation and medical management of staghorn calculi |
Russell S. Terry,Glenn M. Preminger()
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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.
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Received: 28 June 2019
Available online: 17 December 2019
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Corresponding Authors:
Glenn M. Preminger
E-mail: glenn.preminger@duke.edu
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Staghorn. (A) Skeleton of a stag moose, cervalces scotti, housed at the Royal Ontario Museum; (B) Plain abdominal X-ray depicting bilateral staghorn calculi.
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Year | Authors | Patients, n | Renal units, n | Infection stones, n (%) | Proportion of infection stones by gender | Metabolic stones, n (%) | Proportion of metabolic stones by gender | Total No. of patients with metabolic abnormality | Metabolic stone compositions, as reported | 1980 | Resnick and Boyce [19] | 44 | 88 | 26 (59%) | Male: 23%; Female: 77% | 18 (41%) | Male: 55%; Female: 45% | Male: 88%; female 63% | CaP: 17%; CaOx: 17%; Mixed CaP/CaOx: 50%; Cystine: 17% | 1982 | Vargas et al. [27] | 95 | 105 | 77 (98%) | Not given | 1 (2%) | Not given | 18/105 (17%) | Cystine: 100% | 1986 | Wall et al. [20] | 33 | 33 | 21 (64%) | Not given | 10 (30%) | Not given | 26/33 (79%) | Mixed CaP/CaOx: 100% | 1995 | Teichman et al. [21] | 177 | 112 | 40 (36%) | Not given | 68 (61%) | Not given | 46/112 (41%)a | Calcium: 38%; Mixed: 53%; UA: 6%; Cystine: 3% | 2004 | Akagashi et al. [10] | 82 | 85 | 26 (32%) | Male: 35%; Female: 65% | 55 (67%) | Male: 62%; Female: 38% | 14/37 (38%)b | CaP: 12%; CaOx: 14%; Mixed CaP/CaOx: 22%; UA: 17%; Cystine: 2.5% | 2011 | Viprakasit et al. [6] | 48 | 52 | 23 (44%) | Male: 17%; Female: 73% | 29 (56%) | Male: 55%; Female: 45% | 13/48 (27%)c | CaP: 55%; CaOx: 14%; UA: 14%; Cystine: 10% | 2013 | Shafi et al. [9] | 45 | 45 | 4 | Male: 50%; Female: 50% | 39 | Not given | Not given | CaOx: 47%; UA: 18%; Mixed CaP/CaOx: 16%; Cystine: 4.4% | 2017 | Haden et al. [7] | 72 | 75 | 28 (39%) | Male: 43%; Female: 57% | 44 (61%) | Male: 48%; Female: 52% | Not given | CaP: 52%; CaOx: 18%; UA: 18%; Cystine: 12% |
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Prior publications of staghorn calculus case series in which stone type is identified.
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