The Clinical Outcomes of Conservative Management of Staghorn Calculi from 2011 - 2020: A Single-Center Retrospective Study

Abstract

Introduction: Staghorn calculi remain a large challenge due to its risk of renal deterioration, association with life-threatening sepsis, and complexity of its treatment. Its occurrence is of particular importance because it often carries high morbidity and mortality rates. Untreated stones can lead to urosepsis, recurrent urinary tract infections, renal decline, and death. Surgical intervention has always been the mainstay of treatment of staghorn calculi portraying higher survival rates as compared to conservative management. However, there are patients who had conservative management, who survived and even showed improvement of their estimated glomerular filtration rate, signifying that this intervention is not as unsafe as it was previously perceived to be. Objectives: This study aims to investigate the clinical outcomes of conservative management of patients with staghorn calculi. Methods: This is a single-center, retrospective study of 40 enrolled patients admitted at Perpetual Succour Hospital, Cebu City, from January 1, 2011 to December 31, 2020. Patients who are 18 years old and above, with or without co-morbidities, admitted, and diagnosed with unilateral or bilateral staghorn calculi via computed tomography scan, ultrasound, or intravenous pyelography were included; while patients who are below 18 years old, with lithiasis other than staghorn calculi, end-stage renal disease, and terminally ill were excluded from the study. Data was collected through chart review to answer the general and specific objectives. The patients enrolled were followed-up through a call to evaluate clinical outcomes. A chi-square test was utilized to determine the association of categorical factors and the clinical outcomes of patients with staghorn calculi managed conservatively. Results: Forty patients qualified for the study. Most of the patients were elderly or aged more than 60 years old (40%), predominantly female (60%), and mostly dependents (55%). They are all Filipino (100%) and mostly fall under the healthy weight class with a BMI of 18.5 to < 25 cm (37.5%). Most of them were hypertensive (57.5%) and diabetic (30%), and they also had a family history of hypertension (47.5%) and diabetes mellitus (37.5%) mostly. They were predominantly non-smokers (80%), non-alcoholic beverage drinkers (72.5%), and had no history of illicit drug use (100%). On admission, most patients had an eGFR of 30 - 44 (25%) followed by an eGFR of 60 - 89 (22.5%). The most common signs and symptoms presented were flank pain (35%) and fever (30%). Most of them had a unilateral staghorn calculi on the right (47.5%) with a size of 2 to < 5 cm (42.5%). They were mostly deemed unfit for surgical intervention (82.5%) with the reason most commonly due to an ongoing urinary tract infection (35%) and some having sepsis/septic shock (32.5%). For the conservative treatment, most of the patients received antibiotics (90%), followed by hydration (75%) then urine alkalinizers (62.5%). Out of the 40 patients who received conservative treatment, only 3 patients or 7.5% had a stone-related mortality. Meanwhile, 57.5% had UTI/Recurrent UTI and 15% succumb to renal deterioration requiring dialysis. Conclusion: This study concludes that the conservative management of patients with staghorn calculi in Perpetual Succour Hospital presented with a low stone-related mortality (7.5%), with most of the patients having a urinary tract infection/recurrent urinary tract infection (57.5%), and only a few of the population (15%) succumbed to renal deterioration requiring dialysis. This type of intervention can be done especially in select patients.