To evaluate the outcomes of conservatively managed staghorn calculi, specifically looking at morbidity and mortality, incidence of infections and progressive changes in renal function.
Twenty-two patients with unilateral or bilateral staghorn calculi, who were treated conservatively, were included.
Patients were reviewed yearly with symptom assessment, urine culture and measurement of eGFR.
The presentations to urology were incidental (41%), haematuria (36%), abdominal discomfort (5%) and recurrent urinary tract infections (18%). The reasons for conservative management in the cohort were co-morbidities (59%), patient choice (36%) or poor access/anatomy (5%). Results for the whole cohort showed rates of recurrent urinary tract infections (50%), progressive renal failure (14%), disease specific mortality (9%), dialysis dependence (9%) and hospital attendances due to stone-related morbidity (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% and 80%) in favour of the unilateral group. Although there was a decreased incidence in urinary tract infection (41% vs. 80%), renal deterioration (6% vs. 40%) and dialysis requirement (6% vs. 20%) in the unilateral group, these findings were not statistically significant.
From the results we have concluded that conservative management of staghorn calculi is perhaps not as unsafe as previously thought. Careful patient selection, to include unilateral asymptomatic stones with minimal infection and thorough counselling to the risks of conservative management could make it a suitable option for specific patient groups. This article is protected by copyright. All rights reserved.
BJU international. 2015 Dec 14 [Epub ahead of print]
P G Deutsch, K Subramonian
Queen Elizabeth Hospital Birmingham, Department of Urology. , Queen Elizabeth Hospital Birmingham, Department of Urology.