A clinical Observation on Staghorn Calculi of the Kidney

Koo, Dug Cheon; Min, Byung Kap

Abstract

A clinical observation was made on 47 patients of renal staghorn calculi who were admitted to the Department of Urology, Chonnam University Medical School during the 6 years period from January, 1977 to December 1982. The following results were obtained. 1. There were 24 men and 23 women with a ratio of 1.04:1. The age of three-fourths patients of renal staghorn calculi ranged from 40 to 59 years, with peak age incidence in the fifth decade. 2. Prominent symptomatology was present in 44 patients and 3 patients were asymptomatic. In the symptomatic group flank pain was present in 40 cases, hematuria in 13 and recurrent urinary tract infection in 2. Of the asymptomatic patients 2 had significant bacteriuria and 1 had a nonfunctioning kidney on excretory urogram. 3. The calculus was unilateral in 40 patients (right side in 26 and left side in 14) and bilateral in 7. 4. The majority of the patients with renal staghorn calculi showed abnormal urine; finding and relatively well preserved renal function on excretory' urogram. 5. Preoperative urine cultures yielded l0s colonies per ml. organisms in 15 of the 31 patients (48.4%): Escherichia coli in 4, Proteus & Pseudomonas in 3 respectively, Staphylococcus & Enterobacter in 2 respectively and Klebsiella in 1. 6. A total of 47 operations was done in 47 patients. Of the 47 operations 4 were nephrectomies. Stones were removed in 43 patients (43 kidneys). Of the 43 kidneys extended pyelolithotomy was done for 22, pyelonephrolithotomy for 14, anatrophic nephrolithotomy for 4 and nephrolithotomy for 3. 7. A nephrostomy extended into the upper ureter was located in 18 patients (41.9%), There was no difference in duration of nephrostomy tube inlaying between extended pyelolithotomy and pyelonephrolithotomy. 8. Postoperative complications included remnant stone in 14patients(32.6%), hematuria in 11, pyelonephritis in 5 and urinary leakage from nephrostomy site more than 2 weeks in 3. 9. A chemical stone analysis, available in 36 patients, revealed apatite in 20, struvite in 12 and calcium oxalate in 4. A combination of struvite with apatite was present in 8 and of apatite with calcium oxalate in 7 of these 36 cases.