Staghorn Calculus - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Staghorn calculus, or kidney stones, mainly occur due to recurring urinary tract infections caused by some bacteria. These stones are made of struvite, which consists of phosphate, magnesium, and ammonium. They are called staghorn due to their shape, which appears like branching antlers or horns on a deer; thus, they are also called branching kidney stones. These stones often block the pelvis or urine drainage system and lead to kidney failure.The article discusses staghorn calculus and its causes, symptoms, diagnosis, and treatment.

What Are the Causes of Staghorn Calculus?

Staghorn calculus mainly develops during urinary tract infections. The bacteria that produce urease enzymes cause urine to become less acidic, which in turn forms kidney stones.

In addition, other causes of staghorn calculus include:

• Prolonged use of catheter.

• Structural abnormalities that lead to kidney stone formation itself.

• Untreated kidney stones.

• Urinary tract blockages.

• Recurrent urinary tract infections.

• Metabolic disorders, such as hyperparathyroidism.

What Are the Symptoms of Staghorn Calculus?

Staghorn calculus in the kidneys produces the following symptoms:

• Staghorn calculus causes hematuria or blood in the urine.

• Chills and fever, which indicate severe infection, are also signs of this condition.

• Pyuria, or pus in urine, is also present.

• Tiredness.

• Mild to severe pain in hips, back, and ribs is also present, which can be stabbing, constant, intermittent, or sharp.

• Cloudy and discolored urine.

• Frequent urination.

• Difficulty passing urine.

Who Are at Risk of Developing Staghorn Calculus?

Staghorn calculus or stones occur in the following cases:

• If a person has recurring urinary tract infections.

• It mainly affects females.

• One has a neurogenic bladder.

• People have different urinary tracts or drainage systems. The urinary tract is not typical.

• Those who have spinal cord injuries.

How To Diagnose Staghorn Calculus?

The doctor diagnosed the staghorn calculus initially through a detailed physical examination. He or she also takes the patient's detailed medical history, including the signs and symptoms experienced, such as urine frequency, pain, and discomfort, and asks about any past or present history of urinary tract infection. The doctor also advises imaging tests, such as X-rays, CT (computed tomography) scans, and ultrasounds, to view the kidney stones in the urinary tract and establish the location, size, and number of kidney stones, or staghorn calculus.

How Is Staghorn Calculus Treated?

The treatment of staghorn calculus or kidney stones includes:

• Percutaneous Nephrolithotomy for Treating a Staghorn Calculus (PCNL): It is a procedure used to remove large-sized staghorn calculus or kidney stones that cannot pass on or get eliminated independently. The healthcare professional makes a small incision on the back to reach the kidney, places a small temporary tube through the cut, brings the instruments into the kidney, breaks up the stones, and finally removes them from the kidney. A nephroscope is an instrument used during the procedure with a special type of camera to locate the stone and remove it.The procedure is done under general anesthesia, and the person may have to stay in the hospital for one or two days. In some cases, they might leave a small tube in the back for some days while the kidneys are healing or place a ureteral stent, which is a small internal tube in most cases.

• Ureteroscopy or Ureterorenoscopy: This procedure is done through the ureters or the tubes connecting the kidney to the bladder. In this procedure, the doctor uses a specific type of flexible ureteroscopy, which is also called retrograde intrarenal surgery. The healthcare provider can perform the procedure without any incision or cut by passing the instruments through the person’s urethra and to their kidney.

• Ureteral Stent: It is a tubeless surgery. A ureteral stent is a PCNL in which the doctor does not insert the drainage tube in the back. Instead, an internal tube called a stent is placed. A ureteral stent is a small plastic tube temporarily placed in the ureter that helps drain urine from the kidney into the bladder. It is mainly placed to unblock the kidney if a staghorn stone or obstruction is present and to help the ureter stay open post-surgery.

• Combination Therapy: The therapy usually includes antibiotics and pain relievers prescribed by the doctor post-surgery to prevent infections. Combination therapy is mainly opted for because all the treatment options used for managing staghorn calculus have some complications or drawbacks, such as that these procedures are not 100 percent effective, and small fragments of stone are mostly left over in the kidneys. Some treatments may also cause blood loss.

What Is the Prevention for Staghorn Calculus?

Staghorn calculus can be prevented in the following ways:

• One must adhere to dietary changes, avoid beverages and foods high in oxalate, such as tea and spinach, and incorporate fresh fruits and vegetables. A person should also avoid foods irritating the bladder, such as alcohol, caffeine, and spicy foods. This will help minimize the risk of urinary tract infection.

• They must urinate regularly without holding the pee for longer, as this can lead to infections. Urine flushes out bacteria and prevents infections.

• Those suffering from urinary tract infections must consult the doctor and take proper antibiotics to prevent the spread of infections in the kidneys and further formation of staghorn calculos or stones.

• Another important preventive measure is maintaining good hygiene. After using the washroom, one must clean the genitals with water and soap. They must also wear clean and dry underwear to prevent the growth of bacteria and the spread of infection.

What Happens if Staghorn Calculus Is Left Untreated?

In the case of an untreated staghorn calculus, the following medical condition occurs:

• Urosepsis, or fatal urinary tract infection, develops.

• Fluid retention causes swelling in the calyces (caliectasis) of the kidneys to develop.

• Sepsis occurs due to kidney infections caused by xanthogranulomatous pyelonephritis, an inflammatory disorder of the kidneys.

• Kidney failure occurs when they are unable to filter out waste and toxins.

Conclusion

Staghorn calculus is a type of stone in the kidneys, caused by recurrent urinary tract infections. The condition is very painful and uncomfortable, like other types of kidney stones. The condition is usually treated with surgical methods to remove the stone from the kidneys. Therefore, a person experiencing the symptoms of staghorn calculus or kidney stones must consult the doctor immediately. If left untreated, these stones can become fatal and lead to kidney failure due to chronic infection and blockage. This timely diagnosis and management are indeed necessary to treat staghorn calculus.