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Staghorn renal stones: what the urologist needs to know

Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are co...

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Autores principales: Torricelli, Fabio C. M., Monga, Manoj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Urologia 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527092/
https://www.ncbi.nlm.nih.gov/pubmed/32213203
http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.99.07
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author Torricelli, Fabio C. M.
Monga, Manoj
author_facet Torricelli, Fabio C. M.
Monga, Manoj
author_sort Torricelli, Fabio C. M.
collection PubMed
description Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are composed of struvite (magnesium ammonium phosphate) and are linked to urinary tract infection by urease-producing pathogens. Preoperative computed tomography scan and careful evaluation of all urine cultures made prior surgery are essential for a well-planning surgical approach and a right antibiotics choice. Gold standard surgical technique is the percutaneous nephrolithotomy (PCNL). In cases of impossible percutaneous renal access, anatrophic nephrolithotomy is an alternative. Shockwave lithotripsy and flexible ureteroscopy are useful tools to treat residual fragments that can be left after treatment of complete staghorn renal stone. PCNL can be performed in supine or prone position according to surgeon’s experience. Tranexamic acid can be used to avoid bleeding. To check postoperative stone-free status, computed tomography is the most accurate imaging exam, but ultrasound combined to KUB is an option. Intra-operative high-resolution fluoroscopy and flexible nephroscopy have been described as an alternative for looking at residual fragments and save radiation exposure. The main goals of treatment are stone-free status, infection eradication, and recurrence prevention. Long-term or short-term antibiotic therapy is recommended and regular control imaging exams and urine culture should be done.
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spelling pubmed-75270922020-10-14 Staghorn renal stones: what the urologist needs to know Torricelli, Fabio C. M. Monga, Manoj Int Braz J Urol Review Article Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are composed of struvite (magnesium ammonium phosphate) and are linked to urinary tract infection by urease-producing pathogens. Preoperative computed tomography scan and careful evaluation of all urine cultures made prior surgery are essential for a well-planning surgical approach and a right antibiotics choice. Gold standard surgical technique is the percutaneous nephrolithotomy (PCNL). In cases of impossible percutaneous renal access, anatrophic nephrolithotomy is an alternative. Shockwave lithotripsy and flexible ureteroscopy are useful tools to treat residual fragments that can be left after treatment of complete staghorn renal stone. PCNL can be performed in supine or prone position according to surgeon’s experience. Tranexamic acid can be used to avoid bleeding. To check postoperative stone-free status, computed tomography is the most accurate imaging exam, but ultrasound combined to KUB is an option. Intra-operative high-resolution fluoroscopy and flexible nephroscopy have been described as an alternative for looking at residual fragments and save radiation exposure. The main goals of treatment are stone-free status, infection eradication, and recurrence prevention. Long-term or short-term antibiotic therapy is recommended and regular control imaging exams and urine culture should be done. Sociedade Brasileira de Urologia 2020-09-02 /pmc/articles/PMC7527092/ /pubmed/32213203 http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.99.07 Text en https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Torricelli, Fabio C. M.
Monga, Manoj
Staghorn renal stones: what the urologist needs to know
title Staghorn renal stones: what the urologist needs to know
title_full Staghorn renal stones: what the urologist needs to know
title_fullStr Staghorn renal stones: what the urologist needs to know
title_full_unstemmed Staghorn renal stones: what the urologist needs to know
title_short Staghorn renal stones: what the urologist needs to know
title_sort staghorn renal stones: what the urologist needs to know
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527092/
https://www.ncbi.nlm.nih.gov/pubmed/32213203
http://dx.doi.org/10.1590/S1677-5538.IBJU.2020.99.07
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