Urinary tract infection is considered the main risk factor for SC development and thus, affected individuals typically have a medical history of urinary stasis or recurrent infection. Most SC correspond to so-called "infection stones" composed of magnesium ammonium phosphate/struvite, which are characterized by very rapid growth [4] [5]. Indeed, complete SC may form within little more than a month [6]. They rarely pass spontaneously and provoke clinical symptoms in the vast majority of cases. Patients may claim flank pain and constitutive symptoms like fever, nausea and vomiting. SC may be associated with sepsis.

Diagnostic measures may reveal the following:

• Hydronephrosis
• Pyonephrosis
• Xanthogranulomatous pyelonephritis [7]
• Perinephric abscess [8]

Recurrence is likely [4]. If particles of renal calculi remain in the renal pelvis after therapy, they may serve as nuclei for renewed crystallization. Thus, a medical history of urolithiasis should prompt a suspicion of SC and other types of renal calculi.

• Sepsis

  Sepsis syndrome may occur after surgical therapy or endoscopic manipulation of infected or staghorn calculi. Sepsis, which can occur despite perioperative antibiotic use, may be due to bacteremia or endotoxemia. [ncbi.nlm.nih.gov]

  SC may be associated with life-threatening conditions like end-stage kidney disease and sepsis. [symptoma.com]

• Recurrent Urinary Tract Infection

  They are typically encountered in patients with recurrent urinary tract infections. [svuhradiology.ie]

  Staghorn calculus may be associated with recurrent urinary tract infections and renal failure. Shanmugasundaram Rajaian, M.D. Nitin Sudhakar Kekre, M.D. Christian Medical College, Vellore, India [nejm.org]

  […] catheter and recurrent urinary tract infections to look for another cause of recurrent infections. [gmjournal.co.uk]

  Staghorn calculus may be associated with recurrent urinary tract infections and renal failure. ( source: N Engl J Med 2009; 361:1486 October 8, 2009) Other similar posts [anatomybox.com]

• Recurrent Infection

  […] and recurrent stone formation. [radiopaedia.org]

  Urinary tract infection is considered the main risk factor for SC development and thus, affected individuals typically have a medical history of urinary stasis or recurrent infection. [symptoma.com]

  […] catheter and recurrent urinary tract infections to look for another cause of recurrent infections. [gmjournal.co.uk]

• Surgical Procedure

  In most cases with urinary tract calculi, the method has replaced the classic surgical procedure. [ncbi.nlm.nih.gov]

  Of these patients 76 underwent PNL (group-I), 35 sandwich (group-11) and 45 open surgical procedures (group-III). [indianjurol.com]

  A percutaneous nephrolithotomy is a surgical procedure that requires an incision in the back. The surgeon will then insert small instruments into the kidney to remove the stones. Related wiseGEEK Articles [wisegeekhealth.com]

  Operatively, retrograde irrigation should be limited during the surgical procedure. [hindawi.com]

  Both the EUA and AUA recommend antibiotic therapy in the presence of a suspected struvite stones with associated infection; however, while antibiotics are typically given for 1 to 2 weeks prior to the planned surgical procedure, high-level guidelines [liebertpub.com]

• Severe Pain

  One of the most obvious symptoms is pain. The patient may notice pain during urination, as well as a persistent need to urinate. They may also have severe pain below the ribs in their backs and sides, or pain in the groin or lower abdomen. [wisegeekhealth.com]

  Girls wt 26 Kg.. mild fever .. pain at both loin to groin region mild to sever ..pain mostly at right side so what is line of treatment for multiple stone .. medical or surgical... plz ..ur advice Dr. [curofy.com]

  This is common with any severe pain. There may be severe pain in the testis but the testis should not be tender. Blood pressure may be low. [patient.info]

  (blow to the) loin – the pain of kidney stones is classically referred from ‘loin to groin’. [lifeinthefastlane.com]

  It is often described as one of the most severe pains. [1] Although this condition can be very painful, kidney stones usually cause no permanent physical damage. [en.wikipedia.org]

• Dyspnea

  When an acute asthmatic attack fails to subside and becomes refractory to the usual palliative measures which in the past gave relief, the dyspnea becomes severer, cough is unproductive and epinephrine hydrochloride therapy [jamanetwork.com]

  To save this word, you'll need to log in. status asth·mat·i·cus | \ -az-ˈmat-i-kəs \ Medical Definition of status asthmaticus : a prolonged severe attack of asthma that is unresponsive to initial standard therapy, is characterized especially by dyspnea [merriam-webster.com]

  History and Physical Those with pneumonia may present with a wide array of symptoms, but the most common include dyspnea, cough, pleuritic pain, sputum production and fever. [ncbi.nlm.nih.gov]

  A 1996 randomized trial of heliox (70% helium/30% O 2 ) in pediatric asthma subjects admitted to the hospital demonstrated a small but significant improvement in peak expiratory flow, but no difference was noted in clinical outcomes, including dyspnea [rc.rcjournal.com]

  The risk of hospitalization and near-fatal and fatal asthma in relation to the perception of dyspnea. Chest. 2002 Feb. 121 (2):329-33. [Medline]. Summers RL, Rodriguez M, Woodward LA, Galli RL, Causey AL. [emedicine.medscape.com]

• Osteoporosis

   Recurrent stone formers  Strong family history of stones  Intestinal disease (particularly chronic diarrhea)  Pathologic skeletal fractures  Osteoporosis  History of urinary tract infection with calculi  Personal history of gout  Infirm health [slideshare.net]

• Confusion

  The coexistence of these diseases in the same kidney would seem to be important since they are frequently confused with each other. [ncbi.nlm.nih.gov]

  Staghorn calculus: looking beyond the long-term urinary catheter GM, 10 September 2020 A 65-year-old woman presented to the accident and emergency department with low grade fever, confusion due to urinary tract infection. [gmjournal.co.uk]

  Headache, stiff neck, confusion, sleepiness, vomiting, and poor feeding can occur with meningitis. How soon after exposure do symptoms appear? The incubation period varies. [vdh.virginia.gov]

  They can include fever, cough, shortness of breath, chest pain, stiff neck, confusion and disorientation, sensitivity to light, joint pain, chills, ear pain, sleeplessness, and irritability. [wwwnc.cdc.gov]

  If the infection spreads to the brain and spinal cord, it can cause pneumococcal meningitis, characterised by a stiff neck, fever, confusion, and headaches. Pneumococcal infection is responsible for 1-2 million infant deaths worldwide, every year. [news-medical.net]

• Forgetful

  While we are looking for the ideal techniques for management of this very challenging condition, let us not forget the basics of prevention. REFERENCES 1. [scielo.br]

  A patient who has experienced a stone is unlikely to forget the experience and often will arrive at the health-care facility already knowing the diagnosis. Those with recurrent stones may be given medication to keep at home should symptoms recur. [emedicinehealth.com]

• Headache

  Headache, stiff neck, confusion, sleepiness, vomiting, and poor feeding can occur with meningitis. How soon after exposure do symptoms appear? The incubation period varies. [vdh.virginia.gov]

  If the infection spreads to the brain and spinal cord, it can cause pneumococcal meningitis, characterised by a stiff neck, fever, confusion, and headaches. Pneumococcal infection is responsible for 1-2 million infant deaths worldwide, every year. [news-medical.net]

  From start to finish the communication was excellent and all of the paperwork and headaches where managed easily and efficiently. Thanks a million Deb! A great real estate agent very happy with the assistance given and communication. [deborahduffyestateagent.com.au]

• Renal Injury

  Google Scholar 44 : Microdialysis assessment of shock wave lithotripsy-induced renal injury. Urology2000; 56: 364. Google Scholar 45 : Shock wave lithotripsy-induced renal injury. Am J Kidney Dis1991; 17: 445. [auajournals.org]

• Renal Function Impairment

  The clinicians well know how surgical treatment of staghorn calculosis is technically hard to perform, since there is a risk of renal blood vessels injuries and renal function impairment. [ncbi.nlm.nih.gov]

The presence of SC is usually confirmed by means of diagnostic imaging. While most SC are readily observable in images obtained by plain radiography and sonography, computed tomography scans have largely replaced the former: Computed tomography scans allow for an assessment of the overall stone burden, the condition of the renal pelvis and its calyces [9]. Of note, this technique permits for a reliable estimation of a small calculus' volume, but such measures have proven less precise in case of large, branched calculi. The three-dimensional reconstruction of SC may help to resolve this issue [10].

Additionally, laboratory analyses of blood and urine samples should be performed. The former should include measurements of serum electrolyte concentrations, urea and creatinine, and results may not only reveal renal function impairment but also metabolic pathologies that predispose for the development of renal calculi. With regards to urine analyses, the vast majority of SC patients presents with microscopic hematuria and crystalluria. The morphology of urine crystals may indicate the composition of the renal calculus and since most SC are composed struvite [4], "coffin lids" are typically seen upon the microscopic examination of urine sediment. In case of a concomitant urinary tract infection, leukocytes and bacteria may be detected.

• Nephrolithiasis

  Nephrolithiasis (kidney stones) Renal calculus Renal calculus w ureteral calculus Staghorn calculus Staghorn calculus (kidney stone) 592.0 Excludes uric acid nephrolithiasis ( 274.11 ) Applies To Nephrolithiasis NOS Renal calculus or stone Staghorn calculus [icd9data.com]

  Abdomen & Pelvis: Nephrolithiasis - Nonobstructing renal stone (staghorn calculus) Abdomen & Pelvis: Nephrolithiasis - Nonobstructing renal stone (staghorn calculus) < < < Previous page ( ) Next page ( ) > > > < < < Previous chapter ( ) Next chapter [radiologytutorials.com]

  Hidronefrosis. 0 Reply Stag horn kidney stone 0 Reply Emphysematous pylonephritis 0 Reply Staghorn Calculus (Nephrolithiasis) with an isolated Hydronephrosis. [dailyrounds.org]

  Oct 4, 2016 preventive treatment, and practice improvement for nephrolithiasis. [beylikduzuwebtasarim.com]

  It is not uncommon to miss an associated urothelial tumor in a patient of nephrolithiasis preoperatively. [ncbi.nlm.nih.gov]

• Pseudomonas

  Urea-producing bacteria include Proteus, Ureaplasma urealyticum, Klebsiella, Staph species, and Pseudomonas; E. coli does not produce struvite stones. [renalfellow.org]

  Proteus, Klebsiella, Pseudomonas and Enterobacter ). Urease hydrolyzes urea to ammonium with an increase in the urinary pH 3-5. [radiopaedia.org]

A low threshold for imaging should be maintained, as prompt referral to urology for stone removal or treatment is necessary. Staghorn calculi have a high likelihood of leading to renal failure or urosepsis without treatment. [westjem.com]

Discussion We feel that the treatment of choice for large staghorn renal calculi remains PCNL. Nonetheless, in select patients consideration must be given to a staged ureteroscopic approach as primary treatment. [hindawi.com]

Treatment options for unilateral staghorn stone Some clinicians, until the 1970s, believed that staghorn stones should be left alone – no active treatment [20]. [ncbi.nlm.nih.gov]

However, complete staghorn calculus is rare in polycystic kidney disease and predicts a gloomy prognosis of kidney. [ncbi.nlm.nih.gov]

The prognosis for renal SCC is extremely poor, and less than 10% of patients survive for 5 years [5, 6]. Whether or not renal calculi cause SCC is unclear. [karger.com]

Treatment and prognosis 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 [radiopaedia.org]

[…] blood CF cerebrospinal fluid CI chemically induced CH chemistry CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology EH ethnology ET etiology [decs.bvs.br]

Its etiology is associated with urinary tract infection (UTI) caused by bacteria which produce ureases. [scielo.br]

Urease-producing organisms are listed in Etiology. Problem Struvite stones are invariably associated with urinary tract infections. [emedicine.medscape.com]

Allowable Qualifiers English: BL blood CF cerebrospinal fluid CI chemically induced CH chemistry CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology [decs.bvs.br]

Epidemiology of Stone Disease. Urol Clin North Am;34:287–93. (PMID: 22050495) [4] Mishra S, Bhattu AS, Sabnis RB, Desai MR (2014). Staghorn classification: Platform for morphometry assessment. Indian J Urol; 30:80–3. doi:10.4103/0970-1591.124212. [eurorad.org]

Methods: Data from the Informatic Department of Brazilian public health system were obtained as referred to costs in hospital admissions for urinary lithiasis during 2010 and also epidemiological data from 1996 through 2010. [scienceopen.com]

Epidemiology of stone disease across the world. World J Urol. 2017;35(9):1301-20. DOI: https://doi.org/10.1007/s00345-017-2008-6 Ziemba JB, Matlaga BR. Epidemiology and economics of nephrolithiasis. [revurologia.sld.cu]

Possible mechanisms of pathophysiology have been discussed. [ncbi.nlm.nih.gov]

Kidney stones (also called renal calculi, nursing lecture on kidney stones symptoms, treatment, pathophysiology, and causes for the NCLEX exam. [beylikduzuwebtasarim.com]

Sections Struvite and Staghorn Calculi Overview Practice Essentials History of the Procedure Problem Epidemiology Etiology Pathophysiology Presentation Indications Relevant Anatomy Contraindications Show All Workup Laboratory Studies Imaging Studies Show [emedicine.medscape.com]

Urease inhibitors Agents that prevent struvite stone formation via supersaturation, also called ‘urease inhibitors’, were first identified in 1960s. [ncbi.nlm.nih.gov]

Staghorn calculus (SC) is a branched renal calculus that occupies the renal pelvis and at least two the major calyces. SC may fill large parts of the collecting system, though, and partial calculi may be distinguished from complete calculi according to their size and morphology. In this context, the following classification system has been proposed years ago [1]:

• Borderline SC fill the renal pelvis and one major calyx
• Partial SC fill the renal pelvis and two major calyces
• Complete SC occupy the renal pelvis and all major calyces or at least 80% of the collecting system
• Gigantic SC fill the whole collecting system and provoke its dilation

From a clinical point of view, it is important to assess the overall stone burden, the involvement and compromise of components of the collecting system, and possible renal function impairment. SC may be associated with life-threatening conditions like end-stage kidney disease and sepsis. In order to prevent these complications and because the incomplete removal of the renal calculus is likely to result in renewed urolithiasis, it is of utmost importance to assure the complete elimination of SC by means of extracorporeal shock wave therapy, percutaneous nephrolithotomy, retrograde ureteroscopic stone disintegration, open surgery, or any combination thereof [2]. Percutaneous nephrolithotomy is commonly recommended as first-line treatment [3].

1. Di Silverio F, Gallucci M, Alpi G. Staghorn calculi of the kidney: classification and therapy. Br J Urol. 1990; 65(5):449-452.
2. Rassweiler JJ, Renner C, Eisenberger F. The management of complex renal stones. BJU Int. 2000; 86(8):919-928.
3. Healy KA, Ogan K. Pathophysiology and management of infectious staghorn calculi. Urol Clin North Am. 2007; 34(3):363-374.
4. Han H, Segal AM, Seifter JL, Dwyer JT. Nutritional Management of Kidney Stones (Nephrolithiasis). Clin Nutr Res. 2015; 4(3):137-152.
5. Krambeck AE, Lieske JC. Infection-related kidney stones. Clinic Rev Bone Miner Metab 2011; 9: 218.
6. Flannigan R, Choy WH, Chew B, Lange D. Renal struvite stones--pathogenesis, microbiology, and management strategies. Nat Rev Urol. 2014; 11(6):333-341.
7. Zaid UB, Porten SP, Cinman NM, Sanford TH, Breyer BN. Xanthogranulomatous pyelonephritis presenting with a left flank mass. Case Rep Med. 2013; 2013:362194.
8. Tsukagoshi D, Dinkovski B, Dasan S, Jethwa J. Perinephric abscess secondary to a staghorn calculus presenting as a subcutaneous abscess. Cjem. 2006; 8(4):285-288.
9. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008; 28(1):255-277; quiz 327-258.
10. Li H, Chen Y, Liu C, Li B, Xu K, Bao S. Construction of a three-dimensional model of renal stones: comprehensive planning for percutaneous nephrolithotomy and assistance in surgery. World J Urol. 2013; 31(6):1587-1592.