Bilateral Staghorn Calculi in an Eighteen-Month-Old Boy

An 18-month-old white boy was referred to our service for bilateral staghorn calculi noted on a routine chest radiograph. He had a history of prematurity resulting in bronchopulmonary dysplasia and hydrocephalus secondary to an intraventricular bleed. These were managed with furosemide administration during the first 3 months of life and a ventriculoperitoneal (VP) shunt. A conventional abdominal radiograph confirmed the presence of bilateral partial staghorn stones (Fig.1a) which on intravenous urography (IVU) completely filled the lower pole moiety of a left duplex system and partially filled the right lower renal pole collecting system (Fig.1b). A screening urine culture was positive for Proteus mirabilis. Voiding cystourethrogram was normal. Serum creatinine, calcium, phosphorus, uric acid, and parathyroid hormone levels were normal. During a single general anesthetic bilateral pyelolithotomies were performed with intraoperative flexible nephroscopy and electrohydrolic lithotripsy of accessible calyces. Bilateral indwelling JJ stents were placed. The follow-up abdominal radiograph revealed bilaterally reduced stone burdens (Fig.2a). Stone analysis revealed 96 % calcium phosphate (90% carbonate form and 6% hydroxyl form) and 4 % protein. Outpatient extracorporeal shockwave lithotripsy (ESWL) was performed during separate sessions on the left and right remnant stone burdens at 1 and 3 months following open surgery, respectively. Each stone burden received 2,000 shocks at 15 kilovolts using the Dornier HM-3 lithotriptor. Following his last ESWL treatment, the child is free of nephrolithiasis by IVU, renal ultrasonography, and conventional radiography performed at 6, 14 and 23 months respectively (Fig.2b). He does have small stone fragments in his retroperitoneum from his open surgery.