PCNL is suggested as the first-line treatment method for staghorn stones in patients with HK. The treatment of staghorn stones in HK should follow the same guiding principles as for staghorn stones in normal kidney stones. HK is often accompanied by ureteropelvic junction obstruction and abnormal orientation of the calyces, which prevent the passage of the stones. The abnormal position of the renal pelvis also increases the complexity of stone treatment. The management of staghorn stones in HK is challenging because of the variable vascular and anatomic abnormality. This may be due to stasis and infection caused by impaired drainage of the urinary tract, which results in stone formation. Kidney stone is the most common complication in HK, and the incidence of stone disease in HK is approximately 20%. Patients with HK are very susceptible to urinary tract infection, renal calculi, and obstruction. One-third of cases of HK are associated with ureteropelvic obstruction. Due to malrotation of the kidney, the ureter, which links with the renal pelvis, is forced superiorly and laterally. It was reported to have a prevalence of one in 400–800 in the normal population. It is thought to be induced by inadequate head displacement and poor renal rotation due to the clamping of the lower mesenteric artery under the isthmus in the early stages of pregnancy. HK, as the most common congenital malformation, is one of the renal fusion anomalies. In this article, we review the experience in handling staghorn stones under the above circumstances.ģ.1. The most appropriate treatment should be chosen according to the patient's specific conditions so that the patient can benefit the most. In current guidelines, there is no clear suggestion or preferred treatment modality regarding stone treatment in these situations.ĭue to the abnormal anatomy and the overburdened stone, these situations are even more of a challenge for urologists. Common special situations include horseshoe kidney, ectopic kidney (cross-fused ectopic kidney and pelvic ectopic kidney), paediatric kidney and solitary kidney. Surgical approaches for the management of staghorn stones in special situations are still confusing. Mini-PCNL is becoming a prevalent way to manage staghorn stones around the world, and it can reduce the complication rate by using a smaller tract. For its high rate of stone clearance and low incidence of complications, PCNL has been recommended as the most suitable operation method for staghorn stone by the American Urological Association (AUA) since 2005. Traditional treatment options for staghorn stones include extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopy and open surgery. Therefore, staghorn stones should be managed actively by surgical treatment. Conservative treatment of staghorn stones has a tight relationship with renal loss and urosepsis, with an approximate mortality rate of 30%, , ]. The ideal treatment for staghorn calculi involves removing the whole stone by operation, improving the metabolic abnormalities and dealing with anatomic variation. That is, staghorn stones occupy the renal pelvis as well as at least two calyces of the kidney. They can be partial or complete, depending on the level of occupation of the renal pelvis and renal calyces. 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.Īccording to the definition in Campbell's urology and related literature, staghorn stones are defined as large and branched stones that occupy part or all of the collecting system. The decision should be made individually according to the circumstances of the patient. Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon. Treatment methods for staghorn stones have developed rapidly, such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy and laparoscopy and open surgery. The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function. The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications. 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.
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