Bilateral complete staghorn uric acid calculi successfully managed with oral chemolysis

Staghorn stones are typically managed surgically due to their size, complexity, and infection risk. Uric acid stones are an exception. Prior reports of medical dissolution have been limited to small stones (<20 mm). Here, we report a case in which large uric acid staghorn stones were successfully cleared with medical therapy. A 43-year-old male presented with bilateral uric acid staghorn calculi measuring 42 mm (27,155 mm³) and 29 mm (11,562 mm³) and obstructing left ureteral stones that required ureteroscopy. Treatment with febuxostat and potassium citrate resulted in dissolution of the staghorn stones after 15 weeks of therapy, on computed tomography imaging.