International Alliance of Urolithiasis (IAU) guideline on staghorn calculi management

Background: The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing the largest burden and most complex stones, is one of the most challenging cases to practicing urologists in clinical practice. The International Alliance of Urolithiasis (IAU) has released a series of guidelines on the management of urolithiasis.

Purpose: To develop a series of recommendations for the contemporary management management of staghorn calculi and to provide a clinical framework for urologists treating patients with these complex stones.

Methods: A comprehensive literature search for articles published in English between 01/01/1976 and 31/12/2022 in the PubMed, OVID, Embase and Medline database is performed. A series of recommendations are developed and individually graded following the review of literature and panel discussion.

Results: The definition, pathogenesis, pathophysiology, preoperative evaluation, intraoperative treatment strategies and procedural advice, early postoperative management, follow up and prevention of stone recurrence are summarized in the present document.

Conclusion: A series of recommendations regarding the management of staghorn calculi, along with related commentary and supporting documentation offered in the present guideline is intended to provide a clinical framework for the practicing urologists in the management of staghorn calculi.

Wen Zhong¹, Palle Osther², Margaret Pearle³, Simon Choong⁴, Giorgio Mazzon⁵, Wei Zhu¹, Zhijian Zhao¹, Jorge Gutierrez⁶, Daron Smith⁴, Mohamad Moussa⁷, Shashi Kiran Pal⁸, Iliya Saltirov⁹, Mumtaz Ahmad¹⁰, Saeed Bin Hamri¹¹, Ben Chew¹², Albert Aquino¹³, Amy Krambeck¹⁴, Sanjay Khadgi¹⁵, Roger L Sur¹⁶, Selcuk Güven¹⁷, Wael Gamal¹⁸, Jianxing Li¹⁹, Yongda Liu¹, Stefania Ferretti²⁰, Wissam Kamal²¹, Liefu Ye²², Norberto Bernardo²³, Shabir Almousawi²⁴, Mohamed Abdelkareem²⁵, Otas Durutovic²⁶, Guido Kamphuis²⁷, Marcus Maroccolo²⁸, Zhangqun Ye²⁹, Peter Alken³⁰, Kermal Sarica³¹, Guohua Zeng³²

Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark.
Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK.
Department of Urology, San Bassiano Hospital, Vicenza, Italy.
Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
Department of Urology, Al Zahraa Hospital University Medical Center and Lebanese University, Beirut, Lebanon.
Department of Urology, Holy Family Hospital, New Delhi, India.
Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria.
Department of Urology, Ganga Ram Hospital, Ganga Ram Hospital and Fatima Jinnah Medical University, Lahore, Punjab, Pakistan.
Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines.
Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Department of Urology, Vayodha Hospital, Kathmandu, Nepal.
Department of Urology, University of California San Diego Comprehensive Kidney Stone Center, San Diego, CA, USA.
Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
Department of Urology, Sohag University Hospital, Sohâg, Egypt.
Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Urology, Hospital, University of Parma, Parma, Italy.
Department of Urology, King Fahad Hospital, Jeddah, Saudi Arabia.
Urology Department, Fujian Provincial Hospital, Fujian, China.
Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina.
Department of Urology, Sabah Al-Ahmad Urology Centre, Kuwait City, Kuwait.
Department of Urology, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar.
Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia.
Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.
Department of Urology, Hospital de Base of the Federal District, Brasília, Brazil.
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Urology, University Clinic Mannheim, Mannheim, Germany. .
Department of Urology, Medical School, Biruni University, Istanbul, Turkey. .
Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .

Source: Zhong W., Osther P., Pearle M. et al. International Alliance of Urolithiasis (IAU) guideline on staghorn calculi management. World J Urol. 2024 Mar 25;42(1):189. doi: 10.1007/s00345-024-04816-6.

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