Percutaneous nephrolithotomy (PCNL) represents the standard of care for staghorn stones. These “infection stones”, if left untreated, grow rapidly and may lead to deterioration of renal function, end-stage renal disease, and life-threatening urosepsis. Traditionally, staghorn stones have close association with urinary tract infections caused by urea-splitting organisms and consist of pure magnesium ammonium phosphate (struvite) or a mixture of struvite and calcium carbonate apatite. It is usually unilateral and more prevalent in females. This particular form of stone can present with a complete or partial configuration. Staghorn stones are a specific entity of kidney stones that branch out and fill the renal pelvis and part or all of the intrarenal calyceal system. Conservative management of staghorn calculi is an undesired option, but can be an alternative for a carefully selected group of high-risk patients. There is a growing trend of endoscopic combined intrarenal surgery (ECIRS) in concordance with PCNL to treat larger stones. Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones, with significantly less complications rate Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density (STONE) nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases. Staghorn morphometry-based prediction algorithms may predict the number of tract(s) and stage(s) for PCNL monotherapy. New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported, but have not shown utilization in staghorn cases. Wideband doppler ultrasound and real-time virtual sonography can assist. Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus. Non-contrast computerized tomography (NCCT) is indeed the standard imaging tool for percutaneous nephrolithotomy (PCNL) additional tools such as three-dimensional computed tomography (CT) reconstruction of the staghorn calculus may help plan access in complex cases. We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones.
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