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Staghorn Struvite PCNL Complete Removal — ESENeph MCQ

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ModerateRenal Stone DiseaseStaghorn Struvite PCNL Complete RemovalESENeph

A 36-year-old man presents with bilateral loin pain and haematuria. CT shows bilateral renal calculi — left staghorn calculus and multiple right stones. Urine pH is persistently 7.5. Urine culture grows Proteus mirabilis. Stone analysis shows magnesium ammonium phosphate (struvite). What is the definitive treatment for the staghorn calculus?

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Correct answer: E — Percutaneous nephrolithotomy with complete stone removal

Staghorn struvite (infection) stones require complete surgical removal — typically by percutaneous nephrolithotomy (PCNL) — combined with appropriate antibiotic therapy for the underlying urease-producing infection (Proteus, Klebsiella, Pseudomonas). Struvite stones form in alkaline urine (pH >7.0) due to bacterial urease converting urea to ammonia, raising urine pH and promoting magnesium ammonium phosphate crystallisation. Incomplete removal leads to recurrence on residual fragments (nidus for reinfection). ESWL alone is insufficient for staghorn calculi. Antibiotics alone cannot dissolve existing stones. AUA/EAU guidelines recommend complete stone removal.

Reference: https://guidelines.ukkidney.org