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Conservative management of staghorn calculi: a single‐centre experience
Author(s) -
Deutsch Peter G.,
Subramonian Kesavapilla
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13393
Subject(s) - medicine , staghorn calculus , conservative management , asymptomatic , incidence (geometry) , renal function , cohort , urinary system , surgery , conservative treatment , dialysis , mortality rate , percutaneous , percutaneous nephrolithotomy , physics , optics
Objective To evaluate the outcomes of conservatively managed staghorn calculi, specifically looking at morbidity and mortality, incidence of infections and progressive changes in renal function. Patients and Methods A total of 22 patients with unilateral or bilateral staghorn calculi, who were treated conservatively, were included in the study. Patients were reviewed yearly with symptom assessment, urine culture and measurement of estimated glomerular filtration rate. Results The presentations to the urology department of staghorn calculi were incidental (41%), haematuria (36%), abdominal discomfort (5%) and recurrent urinary tract infections ( UTI s; 18%). The reasons for conservative management in the cohort were comorbidities (59%), patient choice (36%) or poor access/anatomy (5%). In the whole cohort the rate of recurrent UTI s was 50%, the progressive renal failure rate was 14%, the disease‐specific mortality rate was 9%, the dialysis dependence rate was 9% and the rate of hospital attendances attributable to stone‐related morbidity was 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 vs 80%) in favour of the unilateral group. Although there was a lower incidence of UTI s (41 vs 80%), renal deterioration (6 vs 40%) and dialysis requirement (6 vs 20%) in the unilateral group, these findings were not statistically significant. Conclusions From the results, we conclude that conservative management of staghorn calculi is not as unsafe as previously thought. Careful patient selection to include unilateral asymptomatic stones with minimal infection, and thorough counselling with regard to the risks, could make conservative management a suitable option for specific patient groups.