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Natural History of Observed Staghorn Calculi: Multi-Institution Update
Britney L. Atwater, MD1, Vikram S. Lyall, MD1, Michael E. Rezaee, MD2, Eric Riedinger, MD3, Bodo E. Knudsen, MD3, Srinath-Reddi Pingle, MD, MS4, David Sanghyuk Han, MD, MS4, Ojas Shah, MD4, Kyochul Koo, MD, PhD5, Ben H. Chew, MD5, Amy Reed, MD6, Ryan Hsi, MD6, Samuel Sorkhi, BA7, Kevin Wymer, MD7, Karen Stern, MD7, Vernon M. Pais, Jr., MD, MS1.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2The Brady Urological Institute, Johns Hopkins, Baltimore, MD, USA, 3Ohio State University Medical Center, Columbus, OH, USA, 4Columbia University Irving Medical Center, New York, NY, USA, 5University of British Columbia, Vancouver, BC, Canada, 6Vanderbilt University Medical Center, Nashville, TN, USA, 7Mayo Clinic Arizona, Phoenix, AZ, USA.

Background: The AUA Guidelines recommend surgical treatment of staghorn calculi in patients fit for surgery; however, some patients opt for observation. Data from >40 years ago report that non-operative management of staghorn calculi is associated with 28% 10-year mortality and up to 70% risk of renal failure or urosepsis within 6 years. Counseling is currently based on non-contemporary data. Herein we provided a multi-institutional update on the natural history of observed staghorn calculi. Methods: A multi-center retrospective review was performed of patients from 6 institutions with an observed staghorn calculus diagnosed on CT scan between 2007 and 2022, with a minimum 6 months of follow up. Data was analyzed regarding stone-related complications and the interval from diagnosis to complication. Results: A total of 73 patients met inclusion criteria with a mean follow up of 49 months (range 6-162). At diagnosis, 89% patients (n=65) declined intervention, and the remaining 11% (n=8) initially elected delayed intervention with a delay of at least 6 months. The overall complication rate was 30% (n=22) for all patients. For the observation cohort, the complication rate was 27.3% (n=19) on average 34 42 months after diagnosis. Of those observed, 19% developed sepsis (n=12, mean 24 24 months), 9% required urgent stent placement (n=6, mean 47 59 months), 2% required urgent nephrostomy placement (n=1, mean 33 months), 8% progressed to renal failure (n=5, mean 18 25 months), and there was an 11% mortality rate (n=7, mean 36 43) with a stone-related mortality rate of 3% (n=2, mean 6 1 months). Conclusions: Delaying or forgoing treatment for staghorn stones is associated with the potential for morbidity and mortality. This contemporary data suggests overall complication rate is approximately 30% with less than one in five patients developing sepsis. This updated data on the anticipated natural history of observed staghorn calculi may contribute to informed shared decision making.


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