Conservative management of staghorn calculi: a single-centre experience

Abstract

Objective: To evaluate the outcomes of conservatively managed staghorn calculi, specifically looking at morbidity and mortality, incidence of infections and progressive changes in renal function.

Patients and methods: A total of 22 patients with unilateral or bilateral staghorn calculi, who were treated conservatively, were included in the study. Patients were reviewed yearly with symptom assessment, urine culture and measurement of estimated glomerular filtration rate.

Results: The presentations to the urology department of staghorn calculi were incidental (41%), haematuria (36%), abdominal discomfort (5%) and recurrent urinary tract infections (UTIs; 18%). The reasons for conservative management in the cohort were comorbidities (59%), patient choice (36%) or poor access/anatomy (5%). In the whole cohort the rate of recurrent UTIs was 50%, the progressive renal failure rate was 14%, the disease-specific mortality rate was 9%, the dialysis dependence rate was 9% and the rate of hospital attendances attributable to stone-related morbidity was 27%. Comparison of outcome measures between the unilateral and bilateral staghorn stones showed statistically significant differences in disease-specific mortality (0 vs 40%) and morbidity (12 vs 80%) in favour of the unilateral group. Although there was a lower incidence of UTIs (41 vs 80%), renal deterioration (6 vs 40%) and dialysis requirement (6 vs 20%) in the unilateral group, these findings were not statistically significant.

Conclusions: From the results, we conclude that conservative management of staghorn calculi is not as unsafe as previously thought. Careful patient selection to include unilateral asymptomatic stones with minimal infection, and thorough counselling with regard to the risks, could make conservative management a suitable option for specific patient groups.

Keywords: calculi; conservative management; renal lithiasis; staghorn calculus; urinary tract infection.