Introduction & Objectives
Since the seminal works by Blandy and Singh, the management of staghorn stones has almost exclusively involved operative intervention. In contrast a more recent study by Deutsch et al, found that conservative management was not as unsafe as previously described. This study sought to examine the available literature to understand the implications of a conservative strategy.
Material & Methods
A systematic search of the literature was carried out using the US National Library of Medicine’s life science database (MEDLINE), EMBASE and the Cochrane Central Register of Controlled Trials. All studies looking at management of staghorn calculi were reviewed and studies with a conservative management arm were identified. Outcomes of interest were recurrent or severe urinary tract infections (UTIs), progressive renal deterioration, dialysis requirements, morbidity and disease specific mortality. Owing to the lack of variance data a descriptive review was carried out.
The review yielded 9 suitable studies involving a total of 332 patients with staghorn calculi managed conservatively. Progressive renal deterioration occurred in 13-36%(mean 20%) with a higher rate amongst bilateral (bil) staghorn sufferers (44% vs 8.8%). Dialysis was required in 9% (20% of bilateral cases vs 6% unilateral cases). The mean rate of severe infection was 17.6% and recurrent UTIs were as high as 50% (80% of bilateral cases vs 41.4% of unilateral cases). Disease specific mortality ranged from 0-67%
We conclude that conservative management of staghorn calculi is not as unsafe as previously thought and selection might favour those with unilateral asymptomatic stones with minimal infection.