Staghorn calculus

Staghorn Calculus is a type of kidney stone that takes the shape of a deer's antlers. It is a large stone that occupies a significant portion of the renal pelvis and the calyces, forming a shape similar to a staghorn. Staghorn calculi are typically composed of struvite (a combination of magnesium, ammonium, and phosphate) and/or calcium carbonate apatite.

Causes

Staghorn calculi are often associated with certain types of urinary tract infections caused by urease-producing bacteria, such as Proteus mirabilis, Klebsiella, Pseudomonas, and Enterobacter. These bacteria can split urea into ammonia and carbon dioxide, leading to an alkaline urine that promotes the formation of struvite and carbonate apatite crystals.

Symptoms

The symptoms of staghorn calculus can vary greatly. Some patients may be asymptomatic, while others may experience severe symptoms such as hematuria (blood in the urine), pyuria (pus in the urine), dysuria (painful urination), renal colic (sharp pain in the lower back), and recurrent urinary tract infections. In severe cases, staghorn calculus can lead to renal failure.

Diagnosis

Staghorn calculus is typically diagnosed through imaging studies. Ultrasound, computed tomography (CT) scan, and intravenous pyelogram (IVP) are commonly used. The stone appears as a filling defect within the renal collecting system.

Treatment

The treatment of staghorn calculus often involves surgical intervention. Percutaneous nephrolithotomy (PCNL) is the most common surgical procedure used. In this procedure, a small incision is made in the patient's back and a nephroscope is passed into the kidney to remove the stone. In some cases, extracorporeal shock wave lithotripsy (ESWL) may be used to break the stone into smaller pieces that can be passed in the urine. Long-term antibiotic therapy may also be required to treat the underlying infection.

Prevention

Prevention of staghorn calculus involves treating and preventing urinary tract infections, maintaining adequate hydration, and in some cases, modifying the diet to reduce the intake of foods high in phosphate.

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