12/2/2023 0 Comments Staghorn calculus meme![]() and Di Silverio classified staghorn stones into: borderline, when stones cover the renal pelvis and one calyx partial, when beside the pelvis, two calices are occupied complete, when stones are in the whole collecting system or 80% of it and gigantic, when the whole collecting system has stones and a dilation of the system occurs. The use of such a scoring diagram allowed a concise description of the complexity and burden of stone in each renal system and facilitated computerized stratification of the upper tract stones. The kidney is divided into pelvis, branches or infundibula and calices. The stone burden was defined as the sum of the longest axial diameter of all stones. ![]() A scoring diagram was used to notify the complexity and burden of stone in the pelvi–calyceal system. Burden was defined as the sum of the longest axial diameter of all stones. subsequently suggested another classification based on complexity, burden and distribution of stone in the pelvi–calyceal system. Finally, the letter “P” denoted functional status of the parenchyma. The letter “R” referred to clinical recurrences. The letter “E” described the excretory tract, with symbols “+” and “−” being used for the presence or absence of dilatation and “e” and “I” for extra- and intrarenal position of the pelvis. They used the acronym CERPUwher the letter “C” described the morphology, size and topography of the stone. in 1984 suggested renal calculus classification according to topography and morphology. The traditional anatomical definition of staghorn calculus is a renal pelvic stone with extension into the renal calyces. Most staghorn stones break easily with the available intracorporeal lithotripters. Traditional open approaches have been replaced with percutaneous renal procedures. There is no specific method of treating a particular staghorn in a given renal unit. They are usually calcium phosphate and hydroxyapatite stones. Secondary staghorn stones are seen in Cushing's syndrome, hyperparathyroidism and renal tubular acidosis. Their fragmentation occurs in large pieces that need to be removed. Whewellite stones and uric acid stones are hard and smooth. These stones are also more prone to recurrence if residual fragments remain. Bacteremia is more commonly associated during lithotripsy. They fragment easily with lithotripters and are easy to clear. Struvite staghorn stones have a higher content of organic matrix, rendering these stones fragile. From a contemporary clinician's perspective stone composition is important because a soft stone would break easily during intracorporeal lithotripsy. ![]() Most of the initial classification schemes have involved morphological and composition based classification. Several groups have proposed classification schemes to better define staghorn calculi taking into account size, morphology and composition. Morphometry-based classification is a natural evolution and attempt to objectively define the clinical complexity of renal staghorn stones. A staghorn stone that one clinician deems inappropriately complex due to its branching pattern or calyceal anatomy, may be standard for another clinician. In the context of surgical recommendations, the treatment pattern is mostly affected by the anatomical attribute of the staghorn calculus. PCNL monotherapy is varied with respect to different approaches for renal staghorn stones in terms of patient position, access, number of tracts, size of the tracts and intracorporeal energy sources utilized. There is also a need for such an objective data with respect to PCNL monotherapy as a standard of care for managing staghorn stones. ![]() Various authors have proposed a uniform objective stone volume or surface area data that would make the assessment in a given scenario more objective. The historical literature is deficient in terms of detailed description of the staghorn stone and, therefore, series across the world are not comparable. This demands a detailed description of stone volume or surface area, distribution of the stone in the PCS and also the PCS anatomy. In the era of PCNL monotherapy, there is a need for standardized nomenclature to quantitate differences in the staghorn complexity. The distribution of staghorn stone burden in the pelvi–calyceal system (PCS) is an important determinant of the complexity of PCNL. The standard of care for renal staghorn stones is percutaneous nephrolithotomy (PCNL) monotherapy. The extension of a renal staghorn stone could be into a few calyces or it may involve all the calyces. Staghorn is classically described as a branched renal calculus. ![]()
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