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Struvite Staghorn Calculus — RACP Adult Medicine MCQ

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HardNephrologyStruvite Staghorn CalculusRACP Adult Medicine

A patient has a complete staghorn struvite calculus, recurrent Proteus bacteriuria and preserved renal function. Antibiotics improve fever but the stone remains unchanged. What is the definitive management principle?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Pursue complete stone clearance with culture-directed antimicrobial management

Explanation lettering: B = shown as A · D = shown as B · A = shown as D

D is correct because an infected struvite staghorn calculus acts as a persistent bacterial reservoir; complete clearance plus culture-directed infection treatment is the definitive strategy. E cannot reliably sterilise biofilm within retained stone. A worsens the alkaline environment that favours struvite. B accepts recurrent infection and renal damage. C ignores the demonstrated urease mechanism. The operative approach is selected by urology according to burden and anatomy.

Reference: Australian CARI Guidelines, Kidney stones: https://www.cariguidelines.org/guidelines/kidney-stones/