Current Practices and Challenges in the Management of Complex Renal Stones in Africa: A Scoping Review

Abstract

This study reviews the challenges and management strategies for complex renal stones in Africa. Historically viewed as infection or struvite stones, recent studies highlight diverse compositions of staghorn stones. These complex stones pose significant risks, including recurrent urinary tract infections and renal impairment. In the past, conservative management of staghorn stones was associated with high morbidity; thus, surgical intervention was necessary for complete eradication. While percutaneous nephrolithotomy (PCNL) remains the standard, it carries notable risks, leading to a shift towards minimally invasive techniques. This study reviews challenges and management practices for complex renal stones and staghorn calculi in African countries, evaluating stone-free rates and associated complications. A scoping review of the literature, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, was performed. A systematic search was conducted in PubMed, African Journal Online (AJOL) and Google Scholar, yielding 1,101 articles, but only 11 articles satisfied the inclusion criteria. The study included 1,513 patients with 1,582 renal units, predominantly male (67.2%) with an average age of 40.7 years. Percutaneous nephrolithotomy (PCNL) was the primary treatment for the majority (71.3%), followed by open surgery (21.9%), laparoscopic surgery (4.1%), and retrograde intrarenal surgery (RIRS) (2.7%). The stone clearance rates for PCNL, open surgery, laparoscopic pyelolithotomy, and RIRS were 82.8%, 83.7%, 100%, and 92.8%, respectively. Stone sizes ranged between 22 and 80 mm, with 66% being staghorn stones. Complication rates were highest for open surgery (30.8%) and lowest for RIRS (4.7%). Despite PCNL being the global standard, African studies still indicate a high reliance on open surgery, likely due to healthcare infrastructure, resource availability and socioeconomic factors. Enhancing access to urological care and addressing healthcare disparities are imperative for improving staghorn stone management in Africa.

Keywords: africa; complex renal stones; kidney; percutaneous nephrolithotomy (pcnl); renal unit; staghorn calculi.

Figure 1. PRISMA flowchart of the study

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; AJOL: African Journal Online. n: Number of Articles

Figure 2. Types of renal stones and percentage representation

Of all the 1582 renal units, 555 (35%) had complete staghorn stones, 482 (31%) had partial staghorn stones, and 545 (34%) had non-staghorn stones. Percentages are represented in the nearest whole number.

Figure 3. Types of surgical interventions

All 1513 patients underwent surgical management for complex renal stones. Among them, 1089 (72%) underwent percutaneous nephrolithotomy, 320 (21.1%) underwent open surgery, 62 (4.1%) underwent laparoscopic pyelolithotomy, and 42 (2.8%) underwent retrograde intrarenal surgery.

Figure 4. Average duration of hospital stay (in days)

The average duration of each type of procedure for renal stones, along with their respective standard errors, is represented in the figure.