Long-Term Renal Fate and Prognosis After Staghorn Calculus Management

Abstract

We analyzed retrospectively 177 consecutive staghorn calculus patients to determine risk factors for ultimate renal deterioration and renal cause specific death. Mean followup was 7.7 years. Overall rate of renal deterioration was 28 percent. Renal deterioration was associated more frequently among patients with solitary versus nonsolitary kidneys (77 percent versus 21 percent, p less than 0.001), previous versus initial stones (39 percent versus 14 percent, p = 0.03), recurrent versus nonrecurrent calculi (39 percent versus 22 percent, p = 0.07), hypertension versus normotension (50 percent versus 22 percent, p = 0.006), complete versus partial staghorn calculi (34 percent versus 13 percent, p = 0.02), diversion versus no diversion (58 percent versus 19 percent, p less than 0.001) and neurogenic bladder versus normal voiding (47 percent versus 21 percent, p = 0.006), as well as those who refused treatment versus treated patients (100 percent versus 28 percent, p less than 0.001). No patient with complete clearance of fragments died of renal related causes compared to 3 percent of those without clearance of fragments and 67 percent of those who refused treatment (p less than 0.001). Our study suggests that long-term renal preservation in the staghorn calculus patient may depend on normal blood pressure, staghorn size, absence of diversion or voiding dysfunction, and complete stone eradication.