Renal stones, especially partial staghorn calculi, are typically associated with significant morbidity and often necessitate invasive procedures such as PCNL (Percutaneous Nephrolithotomy). However, advancements in endourology, particularly in Retrograde Intrarenal Surgery (RIRS), have enabled the treatment of select larger renal stones without any incisions. This case highlights the effective use of RIRS in treating a 25 mm partial staghorn calculus in a young adult male patient at Institute of Urology, Jaipur, under the expert care of Dr. M. Roychowdhury and Dr. Rajan Bansal.
Case Presentation
A 34-year-old male presented to the OPD with complaints of left-sided flank pain persisting for the past few weeks. The pain was dull, non-radiating, and increased with physical activity.
Initial Investigations
- Ultrasound (USG) of the abdomen revealed a partial staghorn calculus measuring approximately 25 mm in the left kidney with mild hydronephrosis.
- To further evaluate the renal function and anatomy, an Intravenous Pyelogram (IVP) was performed, which confirmed the findings. Importantly, the left kidney demonstrated adequate function and no anatomical obstruction beyond the stone burden.
Treatment Plan
While RIRS is generally preferred for stones <20 mm, this case was taken up for RIRS based on:
- Favorable anatomy
- The stone’s partial staghorn morphology (not completely branching)
- Absence of gross hydronephrosis
- High experience and surgical confidence of our senior urologists (Dr. M. Roychowdhury & Dr. Rajan Bansal)
After thorough counseling with the patient and family, and in consideration of the patient’s preference for a minimally invasive approach, a decision was made to proceed with RIRS.
Procedure Details
- RIRS (Retrograde Intrarenal Surgery) was performed the same day using a high-definition flexible ureteroscope.
- The entire 25 mm partial staghorn stone was successfully fragmented and removed in a single sitting using a Holmium:YAG laser, without the need for any cut or incision on the body.
- A Double-J (DJ) stent was placed to aid postoperative healing and to ensure smooth drainage from the kidney.
Postoperative Course
- The patient had minimal discomfort and was discharged the next day, walking independently and eager to resume daily activities.
- He was asymptomatic, and there were no intraoperative or postoperative complications.
- The DJ stent will be removed after 3–4 weeks. Patients are reassured that stent removal is typically quick, painless, and well-tolerated in most cases.
Discussion
Partial staghorn calculi have traditionally been treated with PCNL, particularly due to the stone’s size and potential for branching. However, RIRS is increasingly becoming a viable alternative, particularly in centers of excellence with expertise in high-volume stone management.
While studies suggest that RIRS has higher retreatment rates for stones >20 mm, selected cases like this—based on stone location, renal anatomy, and surgical skill—can be successfully treated in a single session. Multiple recent papers, including one published in World Journal of Urology, confirm the growing use of RIRS for stones up to 30 mm in selected patients with stone-free rates approaching 80–90% in experienced hands. We at Institute of Urology, Jaipur have been able to achieve 100% success rates as of now in such stones.
Conclusion
This case demonstrates that carefully selected patients with stones >20 mm, even those with partial staghorn calculi, can be effectively treated using RIRS—without cuts, minimal hospital stay, and rapid recovery. The clinical judgment and extensive expertise of urologists like Dr. M. Roychowdhury and Dr. Rajan Bansal were pivotal in the successful management of this case.
At the Institute of Urology, Jaipur, we pride ourselves on offering world-class care using the most advanced laser technologies and a team of highly skilled doctors and staff. Our hospital integrates consultation, investigation, and surgery seamlessly under one roof, making patient care efficient, personalized, and satisfying.
The patient is now completely symptom-free and has returned to his normal daily routine. For more such inspiring patient stories and information, you can visit our YouTube channel – “Institute of Urology, Jaipur.”
