A 65-year-old woman presented to the accident and emergency department with low grade fever, confusion due to urinary tract infection. She had a decade long history of recurrent urinary tract infections which were attributed to the long-term urinary catheter.

Her urinary tract imaging was never requested. She underwent a computed tomography of her urinary tract and pelvis, which showed a right staghorn calculus (Figure 1).

 

 

Figure 1 Coronal unenhanced computed tomography image shows a densely calcified calculus involving the right lower pole renal calyces and extending into the renal pelvis. The appearance is in keeping with Staghorn calculus.

 

She underwent percutaneous nephrolithotomy to remove right staghorn calculus.

A renal calculus is called Staghorn calculus when the upper urinary tract stones extend into at least two calyces and involve renal pelvis.1 Staghorn calculi are commonly encountered in women due to recurrent urinary tract infections.2

Staghorn calculi are treated surgically and if left untreated, chronic infection due to staghorn calculi can eventually lead to to xanthogranulomatous pyelonephritis.3

Clinicians should consider early imaging of urinary tract in female patients with long term urinary catheter and recurrent urinary tract infections to look for another cause of  recurrent infections

 


Dr Mansoor Zafar, Speciality Registrar. Department of Gastroenterology. Conquest Hospital, East Sussex Healthcare Trust, St Leonards-on-Sea, East Sussex TN37 7RD

Dr. Amarah Kiani, Locum Consultant- Radiology. Department of Radiology Conquest Hospital, East Sussex Healthcare Trust, St Leonards-on-Sea, East Sussex TN37 7RD

Dr. MJH Rahmani, Consultant Physician. Department of Health and Ageing, Conquest Hospital, East Sussex Healthcare Trust, St Leonards-on-Sea, East Sussex TN37 7RD

m.rahmani3@nhs.net 


 

References

  1. Diri, A., and B. Diri. "Management of Staghorn Renal Stones." [In eng]. Ren Fail 40, no. 1 (Nov 2018): 357-62. https://doi.org/10.1080/0886022X.2018.1459306. https://www.ncbi.nlm.nih.gov/pubmed/29658394.
  2. Reilly RF, Reilly R, Perazella MA. Nephrology in 30 Days. McGraw-Hill Professional. (2005) ISBN:0071437010. 
  3. Nissenson AR, Berns JS, Lerma E. CURRENT Diagnosis & Treatment Nephrology & Hypertension. McGraw-Hill Professional. (2008) ISBN:0071447873.