Staghorn Calculus Treatment by PCNL at Institute of Urology, Jaipur: We report the case of a 34-year-old male presenting with left flank pain, found to have a staghorn calculus measuring 28 mm with mild hydronephrosis. Percutaneous Nephrolithotomy (PCNL), a minimally invasive gold standard technique for large renal stones, was performed at the Institute of Urology, Jaipur. The procedure resulted in complete stone clearance with excellent post-operative recovery. This case underscores the institute’s excellence in advanced urological care and the unmatched expertise of its surgical team.
Introduction
Staghorn calculi are complex renal stones that often require active surgical intervention. PCNL remains the treatment of choice for large stones, offering superior stone-free rates with minimal morbidity when performed by experienced hands. At the Institute of Urology, Jaipur, our team specializes in advanced endourological procedures using state-of-the-art technology, ensuring optimal outcomes with minimal invasiveness.
Case Presentation
A 34-year-old male presented with complaints of persistent dull left flank pain over several weeks. He had no history of fever, hematuria, or recurrent urinary tract infections. Physical examination was unremarkable.
Investigations
- Ultrasound KUB: Revealed a 28 mm staghorn calculus in the left renal pelvis with mild hydronephrosis.
- CT Urography: Confirmed the presence of a large branching calculus occupying the renal pelvis and extending into the calyces, with no evidence of obstruction or extravasation.
- Laboratory Workup:
- CBC: Within normal limits
- Serum Creatinine: Within normal limits
- Coagulation profile: Normal
Management
After discussing the case with the patient and his family, we decided to proceed with Percutaneous Nephrolithotomy (PCNL)—a minimally invasive approach providing the best balance of safety and effectiveness for staghorn calculi.
Surgical Procedure
- The patient was positioned prone under general anesthesia.
- Access was gained via the lower posterior calyx under fluoroscopic guidance.
- The tract was dilated, and the nephroscope introduced.
- The stone was fragmented using a lithoclast and retrieved.
- A Double-J (DJ) stent was placed to ensure unobstructed urinary drainage.
- No intraoperative complications occurred.
Postoperative Course
The patient was observed overnight and remained hemodynamically stable. Analgesics were administered as needed, and oral intake was resumed the next morning. He was discharged on post-op day one with instructions for follow-up.
A postoperative ultrasound and X-ray KUB confirmed complete clearance of the stone and resolution of hydronephrosis.
Discussion
Staghorn calculi, due to their size and configuration, pose significant clinical risks including recurrent infections and progressive renal damage. Early and effective management is crucial. PCNL offers high efficacy for complete stone clearance with minimal surgical trauma.
This case is a testament to the world-class capabilities of the Institute of Urology, Jaipur, in managing complex urological cases through minimally invasive techniques. Our center is equipped with the latest instrumentation and imaging support, ensuring precise, safe, and patient-centric care.
The procedure was carried out by Dr. M. Roychowdhury and Dr. Rajan Bansal, whose expertise in the field of endourology is unmatched. Their commitment to precision and excellence ensures consistently high success rates, making our institute a center of excellence for urological surgery in India.
Conclusion
PCNL remains the gold standard for the management of large renal stones such as staghorn calculi. In this case, the patient benefitted from a minimally invasive approach with a short hospital stay and complete recovery. The successful outcome reflects both the advanced infrastructure and the skilled urological team at the Institute of Urology, Jaipur.
