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Dear Dr. Roach: I am a 77-year-old female who recently had an abdominal and pelvic cat scan to rule out diverticulitis, and it came back showing a left staghorn calculus measured at 2-by-3 centimeters. This wasn't present in 2019. I have gas, gas pains, and diarrhea that is typical of IBS, which I have had for years. What causes this calculus, and is there treatment other than surgery? -- Anon.
Answer: A "staghorn" calculus is a kidney stone that has grown to fill up a large part of the collecting system of the kidney. Although a staghorn calculus has classically been associated with struvite (magnesium ammonium phosphate, a type of kidney stone that can only form in the presence of a high urinary pH, which is most typically caused by a chronic infection), staghorn calculi can consists of any of the common types of kidney stones: calcium oxalate, calcium phosphate, uric acid or a combination.
Antibiotics alone cannot cure a struvite stone. Treatment used to mean surgery, but some people have an anatomy that is favorable to lithotripsy (sound waves to break up the stone) and percutaneous nephrolithotomy. The latter uses a surgical instrument through the back and into the kidney, where the stone can be removed a piece at a time. The two treatments are often used in combination.
A urologist is absolutely essential as only they have the expertise to recommend the right treatment for a given person's anatomy.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.