Big stone…

September 14, 2013

Abdomen/Pelvis, CT, Genitourinary, Non-Trauma

Middle-aged male came in with left flank pain…

Staghorn Calculi 1 Staghorn Calculi 2

This patient has a large staghorn calculi with stranding around the area of the expected renal calyx.  This is highly suspect for a calyceal rupture.

This is an excerpt taken from the American Urological Association’s 2005 guidelines on the management of staghorn calculi:

Staghorn calculi are branched stones that occupy a large portion of the collecting system. Typically, they fill the renal pelvis and branch into several or all of the calices. The term “partial staghorn” calculus designates a branched stone that occupies part but not all of the collecting system while “complete staghorn” calculus refers to a stone that occupies virtually the entire collecting system. Unfortunately, there is no consensus regarding the precise definition of staghorn calculus, such as the number of involved calices required to qualify for a staghorn designation; consequently, the term “staghorn” often is used to refer to any branched stone occupying more than one portion of the collecting system, ie, renal pelvis with one or more caliceal extensions. Furthermore, the designation of “partial” or “complete” staghorn calculus does not imply any specific volume criteria.

The guidelines can be found here:


Although all types of stones can grow to staghorn calculi, most are composed of struvite and/or calcium carbonate apatite.  These stones have a strong association with urinary tract infection from organisms that produce urease.  These stones are often causative agents in calyceal rupture, as in the patient above.  Management is dependent on the patient’s symptoms, signs of urosepsis, and multiple other cofactors.  Per the report above, percutaneous nephrolithotomy is the first-line procedure of choice for most patients.  Sometimes shock-wave lithotripsy is required as well as percutaneous nephroscopy.  Please refer to the above guidelines for more information if desired.

Author:  Russell Jones, MD


1.  Preminger GM, et al.  AUA Report on the management of staghorn calculi.  2005.  Accessed 9/2013.

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