The problem of recurrences and infection after surgical removal of staghorn calculi.
A series of 99 consecutively operated patients presenting staghorn stones has been reviewed to ascertain the factors implicated in recurrent calculogenesis. 71.7% of the calculi were infection stones; 50.7% harbored Proteus species bacteria and 33.8% Escherichia coli. Struvite stones were found in 57.6% followed at long distance (18.2%) by carbonate apatite, calcium oxalate (11.1%) and mixed (9.1%) stones. Postoperative assessment revealed 17% residual stones, which enhanced infection in 46.7% of these cases and regrew to form a new dendritic stone in 33.3%; 80% of these repeat stones were struvite. 31.5% of the patients initially freed of their calculi by the operation, had true recurrences, and 56.5% of them had resistant urinary infection, caused by Proteus or E. coli (50%-50%). Progressive growth of the recurrent lithiasis occurred in 61.5% of the infected cases, while 87.5% of the recurrences occurring in patients with sterile urine remained stabilized. In the group of nonrecurring lithiasis (56.8%) only 16% had urinary infection. These results confirm the preponderant role played by infection in the pathogenesis of staghorn "malignant' lithiasis and move the authors to make a plea in favor of postoperative integrated therapy, including the use of long-term antibacterial agents and urease inhibitors.
D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage; D004927:Escherichia coli Infections / Q000150:complications; D006801:Humans; D007668:Kidney / Q000601:surgery; D007669:Kidney Calculi / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D009392:Nephrectomy; D011512:Proteus Infections / Q000150:complications; D012008:Recurrence; D014552:Urinary Tract Infections / Q000150:complications / Q000517:prevention & control*
D000892:Anti-Infective Agents, Urinary