Gao X. et al., 2020: Management of staghorn stones in special situations
Gao X, Fang Z, Lu C, Shen R, Dong H, Sun Y.
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Staghorn stones have always been a challenge for urologists, especially in some special situations, such as horseshoe kidney, ectopic kidney, paediatric kidney, and solitary kidney. The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications. The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function. Treatment methods for staghorn stones have developed rapidly, such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy and laparoscopy and open surgery. Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon. The decision should be made individually according to the circumstances of the patient. In this review, we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.
Asian J Urol. 2020 Apr;7(2):130-138. doi: 10.1016/j.ajur.2019.12.014. Epub 2019 Dec 30. PMID: 32257806. FREE ARTICLE
The authors have written a review of methods applicable for patients with staghorn stones. The basic message is that in most cases PCNL is the first line approach. But is there a place for SWL in some of these patients?
In this regard the authors concluded that SWL might be a suitable alternative for treating children with staghorn stones. The reason for that conclusion was that these stones are relatively small and accordingly easy to disintegrate.
The recommendation for stones in ectopic pelvic kidneys is to make an individual decision. My personal experience is that provided the stone burden is relatively small, SWL might be an excellent alternative.
The authors also discuss the removal of staghorn stones in solitary kidneys and mention “sandwich” therapy as an option: PCNL + SWL + PCNL.
Not mentioned is that staghorn stones mainly are of two types: calcium stones and struvite (infection) stones. In the latter case and particularly when percutaneous catheters are left in place, improved clearance can be achieved by combining SWL and percutaneous chemolysis.