[Management of staghorn calculi]

Area of Science:

• Urology
• Nephrology
• Surgical Technology

Background:

• Staghorn calculi treatment has seen a shift towards combined therapeutic methods over the last 15 years.
• Recent advancements in flexible ureteroscopy and holmium-YAG laser lithotripsy have enabled new combined treatment strategies.

Purpose of the Study:

• To analyze the indications and outcomes of different therapeutic methods for staghorn calculi.
• To correlate treatment efficacy with staghorn calculi complexity.

Main Methods:

• Analysis of treatment results for staghorn calculi using open surgery, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrostomy, and retrograde ureteroscopy.
• Classification of staghorn calculi into four groups based on size, hardness, distribution, and anatomical factors.

Main Results:

• Group 1 (soft, <700 mm²): ESWL with JJ catheter showed 62.5%-72.5% success after 3.2-3.6 sessions; combined retrograde ureteroscopy and ESWL is an alternative.
• Group 2 (<700 mm², hard/central): Percutaneous renal surgery is preferred, with ESWL for residual fragments.
• Group 3 (>700 mm², central/homogeneous): Combined percutaneous renal surgery and ESWL indicated; ESWL alone is insufficient; open surgery with nephroscopy is an option.
• Group 4 (large, complex): Open surgery (sinus approach) with fragment extraction and nephroscopy is recommended.

Conclusions:

• Treatment selection for staghorn calculi should be guided by stone complexity.
• Combined therapies, including retrograde ureteroscopy with ESWL and percutaneous renal surgery with ESWL, offer effective options for specific stone types.
• Open surgery remains the gold standard for extensive and complex staghorn calculi.