WHY AND HOW SHOULD STAGHORN CALCULE BE OPERATED

Abstract

We reported a case of bilateral renal staghorn calculi. The patient was a 54 years old female whose chief complaint was high fever. She was treated by nephrolithotomy on the left side. But she was not operated on the right side because she did not wish a second operation. We observed the postoperative course for 5 years.
In nephrolithotomy, closure of the renal parenchymal incision was made with one layer interrupted suture from the renal capsule to the pelvic mucosa by 2-0 plain cat gut. This method of suture was originally designed by Dr. Taguchi in 1967.
In the follow-up study of the operated side, we could not find recurrent stones and the renal function was preserved within normal limits. Therefore the method of suture is simple and less harmful.
We found no increase of the size of calculus in the non-operated side and the renal function estimated by IVP and renogram had remained within normal limits.
Selective renal arteriography of the operated side showed normal vascular pattern but tortuous arteries, tapering of artery and decreased cortical width were revealed in the non-operated side. Those angiographic findings were compatible with chronic pyelonephritis.
We considered that the change of pyelonephritis had advanced in the non-operated side. This observation gives suggestions that early surgical removal of staghorn calculi is necessary.