Case Report: An occurrence of steinstrasse in retrograde intra renal surgery (RIRS) for large staghorn kidney stone: a difficult experience in managing surgical outcomes

Ponco Birowo,Bobby Sutojo,Nur Rasyid,Widi Atmoko

doi:10.12688/f1000research.22448.2

Ponco Birowo, Bobby Sutojo + Show 2 more

Open Access

https://doi.org/10.12688/f1000research.22448.2

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Abstract

Immediate removal of staghorn kidney stones is important to prevent life-threatening complications. With the advancement of endoscopic technology, retrograde intrarenal surgery (RIRS) is now an alternate treatment to the standard percutaneous nephrolithotomy (PCNL) for stones removal. However, when used to treat large stones (>3cm), RIRS can cause the formation steinstrasse (SS). Here, we present the case of a 68-year-old man with multiple stones in the collecting system of the right kidney after initial treatment with RIRS. After two years of multiple interventions, the SS was completely removed. To prevent this complication in patients, a detailed assessment of the stone (size, location) and renal anatomy should be completed before RIRS is performed.

Highlights

The term “staghorn” describes the configuration of large, branched renal stones that occupy the pelvis and extend to at least two renal calyces
retrograde intrarenal surgery (RIRS) might cause the formation of steinstrasse (SS), especially in large stones (2–3 cm) cases, which requires a series of interventions
The aim of this study is to address the formation of SS and the impact of prolonged treatment on the patient’s psychological health following the use of RIRS for large staghorn stone removal

Summary

Introduction

The term “staghorn” describes the configuration of large, branched renal stones that occupy the pelvis and extend to at least two renal calyces. Immediate removal of the stones is compulsory to prevent serious kidney injury and life-threatening sepsis[1]. According to the American Urological Association, percutaneous nephrolithotomy (PCNL) is the standard treatment for staghorn removal[2]. Urologists have started using retrograde intrarenal surgery (RIRS) to treat large stones as it is less invasive and simpler than PCNL3. RIRS might cause the formation of steinstrasse (SS), especially in large stones (2–3 cm) cases, which requires a series of interventions. This multiple procedure approach to renal stone treatment can impact patient quality of life, especially when the stone is hard (> 1000 Hounsfield Units)[4,5]

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