Staghorn Calculus: Symptoms, Causes, Treatment

What are the symptoms of a staghorn calculus?

Staghorn calculus, also known as staghorn kidney stones, is a large kidney stone that fills the renal pelvis and branches into the calyces of the kidney. Symptoms of a staghorn calculus can vary depending on the stone’s size, location, and whether it causes complications. Common symptoms include:

• Severe Pain: Often experienced as back pain or flank pain, the pain may radiate to the lower abdomen and groin. It can be intermittent or constant and may be severe enough to cause discomfort or distress.
• Hematuria: Blood in the urine, which may cause the urine to appear pink, red, or brown.
• Frequent Urination: Increased urgency and frequency of urination.
• Painful Urination: Discomfort or pain while urinating.
• Nausea and Vomiting: Sometimes associated with the pain and discomfort.
• Fever and Chills: If the stone causes an infection or if there’s a urinary tract infection (UTI), symptoms may include fever and chills.
• Urinary Tract Infection Symptoms: Such as cloudy, foul-smelling urine, and sometimes even fever, if the stone causes or is associated with a UTI.

In some cases, a staghorn calculus may be asymptomatic, especially if it is small or not causing any blockage or infection. However, it often leads to significant complications if not treated, such as infections or kidney damage. If you experience symptoms that suggest a staghorn calculus, it’s important to seek medical attention for proper diagnosis and treatment.

What are the causes of a staghorn calculus?

Staghorn calculi are large kidney stones that take on a shape resembling a stag’s antlers and can fill the renal pelvis and calyces of the kidney. They are typically associated with several causes:

• Chronic Urinary Tract Infections: Often caused by bacteria that produce urease, an enzyme that breaks down urea in urine to produce ammonia. This raises the pH of urine, leading to the formation of struvite stones, which commonly form staghorn calculi.
• Kidney Stones: A history of kidney stones or recurrent kidney stones increases the risk of developing staghorn calculi.
• Metabolic Disorders: Conditions that affect the balance of calcium, phosphate, or uric acid in the body, such as primary hyperparathyroidism or renal tubular acidosis, can contribute to stone formation.
• Anatomical Abnormalities: Structural abnormalities of the urinary tract, such as horseshoe kidneys or other congenital anomalies, can predispose individuals to staghorn calculi.
• Dehydration: Chronic dehydration can lead to more concentrated urine, increasing the risk of stone formation.
• Certain Medications: Medications that increase the risk of stone formation or change urine chemistry can contribute to the development of staghorn calculi.
• Dietary Factors: High dietary intake of calcium, oxalate, or purines, or low intake of fluids can influence stone formation.

Staghorn calculi often require prompt medical attention and treatment due to their potential to cause significant kidney damage or obstruction.

What is the treatment for staghorn calculi?

The treatment for staghorn calculi usually involves a combination of methods to remove the stones and address any underlying conditions. The main approaches include:

• Surgical Removal: In many cases, surgical intervention is required to remove staghorn calculi due to their large size and complex shape. The primary surgical options are:
• Percutaneous Nephrolithotomy (PCNL): A minimally invasive procedure where a small incision is made in the back, and a nephroscope is used to break up and remove the stones.
• Open Surgery: In rare cases, traditional open surgery might be necessary if the stones are very large or if PCNL is not feasible.
• Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure uses shock waves to break the stones into smaller fragments that can then be passed out of the body more easily. It is generally less effective for very large or complex staghorn calculi but might be used in combination with other treatments.
• Ureteroscopy: If the stones have migrated into the ureter, a ureteroscope can be used to remove or break them up, though this is less common for staghorn calculi given their large size.
• Medications: To prevent future stone formation, medications may be prescribed based on the stone composition and the patient’s overall health. These might include medications to reduce urinary calcium, decrease stone-forming substances, or manage urinary infections.
• Management of Urinary Tract Infections: If the staghorn calculi are associated with an infection, antibiotics or other treatments will be required to address the infection and prevent complications.
• Lifestyle and Dietary Changes: Patients may be advised to make dietary changes to prevent future stones, such as increasing fluid intake, reducing intake of high-oxalate foods, or managing calcium and sodium levels.

Each treatment plan is tailored to the individual based on the size, location, and composition of the stones, as well as the patient’s overall health and any underlying conditions.