6/14/2023 0 Comments Staghorn calculus![]() In the latter situation, the opaque collecting system may be attributed to contrast rather than the calculus, especially when staghorn calculi are bilateral. There is usually little differential, provided intravenous contrast has not been administered. If left untreated, staghorn calculi result in chronic infection and eventually may progress to xanthogranulomatous pyelonephritis 5. Percutaneous nephrolithotomy (PCNL) is usually reserved for large calculi near the pelviureteric junction, especially staghorn calculi, which are unlikely to be removable via retrograde access. Staghorn calculi need to be treated surgically, usually PCNL (percutaneous nephrolithotomy) +/- ESWL (extracorporeal shockwave lithotripsy) and the entire stone removed, including small fragments, as otherwise, these residual fragments act as a reservoir for infection and recurrent stone formation. Extracorporeal shock wave lithotripsy (ESWL) is usually performed in large proximal calculi in patients unsuitable for invasive management. When viewed on bone windows they have a laminated appearance, due to alternating bands of magnesium ammonium phosphate and calcium phosphate 5. Staghorn calculi are radiopaque and conform to the renal pelvis and calyces, which are often to some degree dilated. The collecting system is filled with a densely calcified mass, producing marked posterior acoustic shadowing. The vast majority of staghorn calculi are radiopaque and appear as branching calcific densities overlying the renal outline and may mimic an excretory phase intravenous pyelogram. Uric acid and cystine are the underlying components of a minority of these calculi 5. Struvite accounts for approximately 70% of the composition of these calculi and is usually mixed with calcium phosphate thus rendering them radiopaque on both plain films and CT. Urease hydrolyzes urea to ammonium with an increase in the urinary pH 3-5. Proteus, Klebsiella, Pseudomonas and Enterobacter). Staghorn calculi are composed of struvite (chemically this is magnesium ammonium phosphate or MAP) and are usually seen in the setting of recurrent urinary tract infection with urease-producing bacteria (e.g. A conservative approach to its treatment may lead. The majority of staghorn calculi are symptomatic, presenting with fever, hematuria, flank pain and potentially septicemia and abscess formation. A staghorn calculus is a calculus accommodating the majority of a renal calyx extending into the renal pelvis. Staghorn calculi are the result of recurrent infection and are thus more commonly encountered in women 6, those with renal tract anomalies, reflux, spinal cord injuries, neurogenic bladder or ileal ureteral diversion. ![]()
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