Flannigan R et al, 2014: Renal struvite stones-pathogenesis, microbiology, and management strategies.
Flannigan R, Choy WH, Chew B, Lange D
The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
Infection stones-which account for 10-15% of all urinary calculi-are thought to form in the presence of urease-producing bacteria. These calculi can cause significant morbidity and mortality if left untreated or treated inadequately; optimal treatment involves complete stone eradication in conjunction with antibiotic therapy. The three key principles of treating struvite stones are: removal of all stone fragments, the use of antibiotics to treat the infection, and prevention of recurrence. Several methods to remove stone fragments have been described in the literature, including the use of urease inhibitors, acidification therapy, dissolution therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy (PCNL), and anatrophic nephrolithotomy. PCNL is considered to be the gold-standard approach to treating struvite calculi, but
adjuncts might be used when deemed necessary. When selecting antibiotics to treat infection, it is necessary to acquire a stone culture or, at the very least, urine culture from the renal pelvis at time of surgery, as midstream urine cultures do not always reflect the causative organism.
Nat Rev Urol. 2014 Jun;11(6):333-41. doi: 10.1038/nrurol.2014.99. Epub 2014 May 13
This review with 86 references includes only a few general comments on the use of SWL in struvite stones:
“SWL is a minimally invasive option for stone management, but has a limited role for staghorn calculi owing to its poor efficacy in the treatment of large stone burdens.”
“In particular, SWL is useful in the paediatric population as the rate of success is higher than in adults and might potentially avoid a more invasive surgical procedure.”
“SWL has been associated with several potential complications when used to treat staghorn calculi, including sepsis, obstructive nephropathy …”