Giant staghorn stone causing inferior vena cava compression: a novel case report

Area of Science:

• Nephrology
• Urology
• Surgical Innovation

Background:

• Staghorn calculi (SC) are large kidney stones filling the renal pelvis and calyces, common in developing nations.
• Massive SC (>5 cm) are typically treated with open surgery, though percutaneous nephrolithotomy (PCNL) is standard for large stones.
• Literature on PCNL for massive SC is scarce, especially for stones compressing vital structures like the inferior vena cava (IVC).

Purpose of the Study:

• To report the successful management of massive bilateral staghorn calculi using PCNL.
• To highlight the feasibility of PCNL for extremely large renal stones, including those causing IVC compression.

Main Methods:

• A 63-year-old male with polycythemia vera presented with massive bilateral staghorn calculi.
• CT revealed stones of 7.3×5.5 cm (right) and 1.8×4.5 cm (left), with the right stone compressing the IVC.
• Right-sided PCNL was performed, utilizing ultrasound guidance.

Main Results:

• PCNL achieved 80% fragmentation of the massive right staghorn calculus.
• This represents the first reported case of a renal stone compressing the IVC in the Middle East.
• The procedure was successful without additional interventions.

Conclusions:

• Ultrasound-guided PCNL is effective for treating giant staghorn calculi.
• PCNL can be a viable alternative to open surgery for massive SC, even with IVC compression.
• Further research is warranted on the use of ultrasound-guided PCNL for stones exceeding 5 cm.