Struvite Stones: Treatment – Nephrolithiasis

00:01 How about struvite stones? What do we need to consider in that particular patient population? So struvite stones are also called triple phosphate stones or infections stones.

00:12 They are large in size, they're difficult to eradicate and they oftentimes will form a staghorn calculus meaning that they fill up the entire renal pelvis in those calyces.

00:23 They are composed of magnesium ammonium phosphate and triple phosphte and calcium carbonate apatite.

00:30 They are associated with urease-producing bacteria, that includes Proteus, Pseudomonas, Klebsiella, Serratia, Ureaplasma and Citrobacter.

00:42 So some of the risks of forming struvite stones are going to be when patients have urinary tract infections.

00:49 There's an increase in propensity to form these struvite stones particularily with those urease-producing organisms that we talked about.

00:56 Women tend to have more struvite stones than men and having a high urinary pH, again with those urease-producing organisms really puts that patient at risk.

01:08 How do we treat struvite stones? Antibiotic therapy is key, remember these are infection-related stones so we have to eradicate that infection.

01:17 Oftentimes unfortunately, that is not enough and our patients will actually require urological intervention.

01:24 So we call our urology colleagues and they can do a complete stone removal.

01:29 For small stones, they can come in and they can do extracorporeal shock wave lithotripsy.

01:34 So basically, they can actually use a shock wave to break up those stones and let them pass or if it's a larger stone, particularly staghorn calculi or others, they can do a percutaneous nephrolithotomy.

01:48 That's what's shown in this image over here.

01:50 This patient actually has multiple tracks where they've entered percutaneously right into the renal pelvis in order to retrieve the stone.