Dr.rasoulabout 6 years ago

Staghorn stones

A 58-year-old man presented with a 1-year history of dysuria. His medical history was notable for recurrent pyelonephritis on the right side. Evaluation at this time revealed staghorn calculus (Panel A, long arrows) and left ureteric calculus (Panel A, short arrow), with mild renal failure (serum creatinine level, 2.1 mg per deciliter [186 μmol per liter]). A urine culture was positive for Escherichia coli. Renal scanning with the use of 99mTc-labeled diethylenetriamine pentaacetic acid (DTPA) showed that both kidneys were functioning, with the right kidney performing more efficiently than the left. After renal function was optimized by means of percutaneous nephrostomy and treatment with antibiotics, the patient underwent extended pyelolithotomy of the right kidney (the extracted staghorn calculus is shown in Panel B). After surgery, renal function improved and has since remained stable (serum creatinine level, 1.3 mg per deciliter [115 μmol per liter]), and the symptoms of painful urination abated. Percutaneous nephrolithotomy and ureteroscopic lithotripsy on the left side are planned for future treatment. Staghorn calculus may be associated with recurrent urinary tract infections and renal failure. Shanmugasundaram Rajaian, M.D. Nitin Sudhakar Kekre, M.D. Christian Medical College, Vellore, India