Have you developed 'staghorn'-shaped stones in your kidneys? Let's learn about Staghorn Calculus!

Have you ever heard of kidney stones? This is a fairly common problem for some people. But today we are going to talk about a special type of kidney stone. This is called Staghorn Calculus . The name sounds a little strange, doesn't it? "Staghorn" means the antlers of a deer. These stones get their name because they branch out and spread inside the kidney like deer antlers. You can also think of them as coral reefs in the sea.

What is Staghorn Calculus?

Simply put, a staghorn calculus is a type of kidney stone (calculus means stone). But this one is not like other ordinary small stones. It can grow large, branch out, and spread throughout the main canal (renal pelvis) and the small canal system (calyces) that collect urine in the kidney . Imagine that if the kidney were like a factory that makes urine, this stone would be like a big blockage in the pipeline of that factory.

The main cause of these stones is frequent urinary tract infections (UTIs) . The stones that form due to such infections are often made of a chemical called struvite . This is a combination of magnesium, phosphate, and ammonium. Sometimes, a small stone can grow over time and branch out to become a staghorn stone like this one. When that happens, they can form when struvite is mixed with calcium phosphate, calcium oxalate , or calcium carbonate apatite.

Usually, this type of stone forms in only one kidney. However, very rarely, this condition can occur in both kidneys. These stones can cause significant disruption to kidney function, and can even lead to kidney failure .

Who can grow the most of these 'deer antler stones'?

Some people are at higher risk of developing these staghorn stones. Let's take a look at who they are:

• For women: This condition is more common in women than in men.
• For those who get frequent urinary tract infections (UTIs): As mentioned before, this is a major cause.
• For those with an abnormal shape or changes in the urinary system: If there is any weakness in the flow of urine, it is easier for stones to form.
• For those with spinal cord injuries.
• For those with neurogenic bladder: This refers to those whose bladder function is impaired due to nerve damage.

How do staghorn stones affect our bodies?

Staghorn stones can cause partial or complete blockage of the kidneys. Think of it like a large object blocking a water pipe. The branches of this stone extend into the renal pelvis , a funnel-like part of the kidney that collects urine. From there, urine travels down two small tubes called ureters to the bladder. So, if either the renal pelvis or the ureter becomes blocked, the kidney begins to swell.

Also, these stones can block the calyces of the kidney, where urine first collects. If the calyces swell due to the extra fluid, it is called caliectasis . If this is not treated properly, the kidneys can fail.

What are the symptoms of this?

If you have a staghorn stone in your kidney, you may experience symptoms like:

• Fever.
• Side pain between the ribs and the hip. This can also feel like back pain.
• Blood in the urine (hematuria). The urine may turn red or dark brown.
• Pus with urine (pyuria). The urine may be cloudy, milky, and may have a foul odor.
• Feeling extremely tired.

Sometimes these large stones may be present but without any symptoms . That is the most dangerous thing. These stones may be found accidentally during a test done for another reason.

Why do stones like this form? What are the causes?

As mentioned earlier, frequent urinary tract infections (UTIs) are a major cause. In particular, some types of bacteria that cause infections produce an enzyme called urease . For example, the bacteria Proteus mirabilis . This enzyme lowers the acidity (pH) of your urine, which means it becomes more alkaline. Then, crystals form, which clump together and start forming kidney stones.

There are other reasons too:

• Anatomical differences: Some people are more prone to developing stones due to certain congenital differences in their urinary system.
• Urinary tract obstruction.
• Using a urinary catheter for a long time.
• If you have previously had a urinary diversion procedure.
• Neurogenic bladder condition.
• Having kidney stones that have been untreated for a long time. Small stones can grow larger and cause this condition.

How do doctors detect this?

If you have symptoms, a doctor will first ask you questions and do a physical exam. They may then order tests such as:

• X-ray examination of the kidneys: Staghorn stones are usually radiopaque . This means that these stones are not transparent to X-rays and therefore show up clearly on an X-ray image.
• CT Scan (Computed Tomography - CT scan): This can clearly see the size, shape, and location of the stone. Often, a CT scan is performed if a staghorn stone is suspected.
• Urine tests: Check for infection, blood, or pus.

How is it treated?

Treating staghorn stones usually involves surgery . The stone must be completely removed, not even small pieces. Otherwise, those small pieces can cause infection and new stones to form.

Important: Staghorn stones are a condition that can damage the kidneys, so if a doctor recommends treatment, it's best to do it quickly.

There are several main treatment methods used:

1. Percutaneous Nephrolithotomy (PCNL)

This is the most common surgical procedure used to remove staghorn stones. PCNL is a procedure that removes large stones in the kidney, stones that are too large to pass through the urine.

• How is it done?: The surgeon makes a small cut in your back, near your kidney. A small tube is temporarily inserted through the cut into your kidney. Then, a special camera-equipped instrument called a nephroscope is inserted through the tube to find the stone and either break it into pieces or remove it completely.
• Anesthesia: This surgery is performed under general anesthesia .
• Hospital stay: You will usually stay in the hospital for a day or two. Sometimes, a small drainage tube may be left in place for a few days until the kidney heals. However, most often, a ureteral stent , a small tube that stays inside the body, is placed instead.

2. What is a ureteral stent?

You may have heard of "tubeless surgery," which means that a drainage tube is left in the back after a PCNL procedure. However, a stent can still be placed inside.

A ureteral stent is a small plastic tube that is temporarily placed inside the ureter , the tube that carries urine from the kidney to the bladder. It is placed:

• If your kidney is blocked, whether due to a stone or some other obstruction, help remove it.
• After surgery, the ureter should be kept open to help urine flow properly.

This stent is usually removed in a few weeks.

3. Ureteroscopy treatment

A ureteroscopy is a procedure in which a surgeon looks through the ureters , the tubes that connect the kidneys to the bladder. This also uses very small instruments. It is also called a ureterorenoscopy . You may also hear it referred to as a URS or a U-scope .

A special type of this is flexible ureteroscopy , also known as retrograde intrarenal surgery (RIRS) . This involves inserting instruments through the urethra without any incisions and into the kidney to treat the stones. This procedure is usually used for small stones or for small fragments left after PCNL. PCNL is the mainstay for staghorn stones.

4. Other Lithotripsy Methods

There are other methods of stone crushing. For example, laser methods such as Holmium laser lithotripsy or Thulium fiber laser lithotripsy can be used to break up stones. These can be used in conjunction with PCNL or Ureteroscopy.

5. Combination therapy

Sometimes, a single treatment method may not be able to completely remove the stone. In that case, several treatments may need to be used together.

Know: All treatments have some risks. Small pieces of stone may remain. There may be some bleeding. After the surgery, your doctor will give you antibiotics and painkillers. There is also a risk of infection because urine is not clean.

How can I reduce the risk of these stones recurring after treatment?

After a stone is removed, you can try to prevent it from forming again. The following things can help:

• Following specific diet recommendations from your doctor: Your doctor will tell you what to eat and what not to eat depending on the type of stone. For example, they may tell you to drink plenty of water.
• Taking urease inhibitor medications like acetohydroxamic acid : These are rarely given, especially to people who develop struvite stones, to block the urease enzyme.
• Taking antibiotics to prevent infections: If you have frequent urinary tract infections, your doctor may recommend that you continue taking antibiotics at a low dose.

What happens if you have a staghorn stone? What if it is not treated?

If you have a staghorn stone and are treated properly , you will be able to urinate normally and the pain will go away. You may or may not get a stone again. It varies from person to person.

However, if a staghorn stone is left untreated , it can lead to dangerous conditions such as:

• Xanthogranulomatous pyelonephritis: This is a severe infection of the kidneys. It can cause sepsis, a life-threatening, systemic infection.
• Caliectasis: Swelling of the calyces of the kidney due to fluid retention.
• Renal failure: The kidneys lose their ability to filter waste products. This can be fatal.
• Urosepsis: A severe infection of the urinary system. This can also be fatal.

However, if some people are in a situation where surgery is not possible (due to age or other illnesses), they can live with non-surgical treatment (conservative management) under the constant supervision of a doctor.

How long does it take to heal?

Recovery time varies depending on the treatment. If you have major open surgery, it will take longer to recover. However, with minimally invasive procedures like PCNL, you may be able to go home the same day. Your doctor will tell you when you can return to work, school, and weight-bearing activities.

When should you see a doctor?

After treating a staghorn stone, see a doctor or go to a hospital immediately if you have any of these symptoms:

• If you have a fever over 100 degrees Fahrenheit (about 37.8 Celsius).
• If you feel cold and shivering (chills/shaking).
• If the bleeding does not stop or increases.
• If the pain does not decrease or increases.
• If you can't urinate.

Finally, things to remember

Staghorn stones, like other kidney stones, can be a bit annoying and painful. But don't worry. Your doctor can examine you and give you the best solution. In most cases, that solution may be surgery. It is essential to treat staghorn stones if possible to prevent kidney failure.

Follow your doctor's diet, exercise, and other instructions exactly. Then you can recover quickly and stay healthy. Got it? If you have any questions, never be afraid to ask your doctor.

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