Nevertheless, it may be difficult for patients to undergo RIRS when deformity of the pelvis and urinary tract is present ( 10). This is especially suited for patients with a solitary kidney.

Therefore, RIRS is an excellent alternative for patients who prefer to undergo a safer procedure or who may suffer experience consequences from PCNL but still expect to achieve adequate efficacy. Another severe complication is renal collecting system injury (up to 8%), which may result in electrolyte disorder, changes of mental status, and intravascular volume overload ( 9). By contrast, performing PCNL to manage staghorn calculi has been significantly associated with intraoperative bleed of the kidney on account of large calculi and multiple percutaneous punctures. Consequently, RIRS may become the sole option due to general health conditions and patient preference ( 8). Most notably, RIRS is less invasive and has a low rate of intraoperative and postoperative complications, mainly urinary tract infection and fever ( 7). As a result, it has become increasingly popular in the treatment of larger stones >2.0 cm, including staghorn stones ( 6).

Although RIRS has been reported to have a lower stone-free rate compared to PCNL when managing kidney stones larger than 2.0 cm ( 5), the past few decades have seen technological advances and refinements that have substantially improved the stone-clearance rate of multisession RIRS. PCNL has been the first-line treatment of staghorn calculi ( 3), and RIRS is recommended by guidelines as the first-line treatment for kidney stones ≤2.0 cm ( 4).

The invasive procedures to treat this disease include percutaneous nephrolithotripsy (PCNL) and retrograde intrarenal surgery (RIRS). Nephrolithiasis is a prevalent illness that affects 5% of the population in the United States ( 1), with 10% to 20% of these cases being staghorn calculi ( 2). This suggests RIRS may be of particular interest in minimizing the procedure-related damage of a solitary kidney. This case demonstrates that RIRS is a safe and effective treatment of staghorn calculi with the presence of urinary tract deformation. The patient recovered well without any complications. The postoperative X-ray exam of the third session revealed that the renal stone was completely removed. A total number of 3 sessions of RIRS were conducted, and the patient was discharged 3 days after each session on average. Additionally, a urinary tract deformity was observed, and it was secondary to the deformity of the pelvis caused by a previous pubis fracture, which significantly increased the risk and the difficulty of intrarenal surgery. The computed tomography (CT) scan found a solitary kidney on the right side with an opaque 4.5 cm × 2.4 cm renal stone and grade I hydronephrosis. The 37-year-old male patient presented with right-sided lumbar pain. However, we report a retrograde intrarenal surgery (RIRS) performed to treat a staghorn calculus in a patient with a solitary kidney and a deformed urinary tract. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn calculi.

Staghorn renal calculi are large, branched stones in the kidney that partially or completely fill the renal pelvis and renal calyces.

Staghorn calculus right kidney