Reno alimentary fistula, a rare illness characterized by improper connection between the kidney and digestive tract, can lead to urinary tract infections, abscesses, and severe sepsis. It can also be caused by various factors such as chronic infections, malignancy, cryoablation, or abdominal surgical procedures. We present a case of a 60-year-old man with bilateral staghorn stones who was diagnosed with reno-duodenal fistula and underwent a right simple nephrectomy and fistula closure. The histopathology revealed a well-differentiated squamous cell carcinoma that originated from the renal pelvis.

BACKGROUND: Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico, placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient\'s collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula.
METHODS: A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate.
RESULTS: A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100). A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001).
CONCLUSIONS: Guy\'s Score Grade IV showed a higher incidence of residual lithiasis, seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.

BACKGROUND Nephro-colic fistulas are uncommon, generally caused by local inflammation, trauma, or neoplasia affecting the kidney or the colon. Their association with a coralliform stone is described in a few case reports, but their management is difficult and differs quite a lot, depending on the clinical situation. We report an atypical clinical case of a reno-colic fistula associated with a staghorn calculus. This case adds to the literature an iconography rarely found. CASE REPORT A 68-year-old woman presented to the Emergency Department with respiratory symptoms and chronic abdominal pain. The biological results showed a high inflammatory syndrome. The radiological assessment revealed a retroperitoneal and left retro-renal abscess, attributed to a left nephro-colic fistula associated with the partial passage of a lithiasis within the colonic lumen. Colonoscopy confirmed the diagnosis. Multiple recurrences of diverticulitis in this region could be the origin of the complication. First, the patient was treated with antibiotic therapy and radiological drainage. Second, she benefited from a left nephrectomy, left segmental colectomy, and splenectomy. The clinical and radiological evolution were favorable after surgery. The follow-up was disrupted by hospitalizations in the Cardiology Department for cardiac decompensation. CONCLUSIONS Kidney stones along with local inflammatory phenomena can be the cause of a nephro-colic fistula. Due to the lack of guidelines in such cases, their diagnosis and management are difficult to ascertain. Surgery is the right course of treatment.

Renoduodenal fistulas are a rare and uncommon phenomenon that account for ˂1% of those found between the urinary and intestinal tracts. Precipitation of this pathologic tract can be caused by chronic inflammation, necrosis, or ischemia. This case illustrates a 72-year-old man presenting with flank pain discovered to have multiple renoduodenal fistulas and our approach that led to the resolution of his symptoms. We review the pathophysiology, management, and effects of these fistulous tracts on renal function. Patients with staghorn calculi should undergo immediate evaluation for removal of the stone. In cases complicated by fistula formation, need for radical nephrectomy should be investigated and surgical repair should be pursued.

Percutaneous nephrolithotomy is the gold standard treatment for staghorn calculi. However, this study reviews a case of an almost complete removal of staghorn calculi following one session of retrograde intrarenal surgery with intelligent control of renal pelvic pressure (RIRS-ICP). A 45 years-old female patient with an 8.3 × 4.5 cm complete staghorn stone was infected with Proteus mirabilis. Two sensitive antibiotics, piperacillin tazobactam and etimicin, were administered for 3 days. Semirigid 7/8.4 Fr ureteroscope was used to treat the renal pelvis and upper calyceal calculi for 57 min. A 550 μm holmium laser fiber with 2.0 J × 30 Hz was set. Next, a disposable flexible ureteroscope of 8.4 Fr was used to address residual middle and lower calyx stones for 94 min. A 200 μm holmium laser fiber with 1.0 J × 30 Hz was set. The renal pelvis pressure was controlled within 15 mmHg. A 2 mm CT scan on the first postoperative day showed inferior caliceal residue of approximately 1.0 × 0.6 cm. No complications occurred. This suggests that RIRS-ICP is a safe and effective treatment for staghorn calculi.

BACKGROUND: The most common source of pyogenic liver abscess is biliary tract infection. Other less common routes include the spread of bacteria from distant foci. However, direct extension of a perinephric infection focus to the liver is extremely rare.
METHODS: The patient was a non-diabetic, immunocompetent, 29-year-old woman of mixed race ancestry with a history of recurrent urinary tract infections who was referred to our hospital because of an ultrasound-detected liver abscess. She was initially treated with metronidazole for 20 days at the referring institution for suspected amebic abscess without improvement. On admission to our center, she was febrile and complained of a dull right upper quadrant pain. A POCUS ultrasound suggested a pyogenic abscess, probably from a staghorn calculus infection. She received meroperem and amikacin for 22 and 10 days, respectively. Repeat hemocultures showed no growth, but urine cultures were positive for Proteus sp. Complete remission of clinical and imaging findings was observed under antibiotics. The patient was referred to the urology outpatient clinic to discuss the option of radical nephrectomy. CONCLUSION : This case underlines the high morbidity of staghorn calculi.

Staghorn calculus usually fills the pelvis of the kidney, the infundibulum, and most of the calyces. It is a rarity for staghorn stones to be asymptomatic; in addition to that, the calculus discussed in this case report was of a very large size and was removed intact. Open pyelolithotomy, the procedure used, is one that comes with a wide range of complications but can be deemed effective in certain cases. In this scenario, it led to no impediments to normal physiology.
UNASSIGNED: Here the authors report the case of a 45-years-old Nepalese male who presented with a large yet asymptomatic staghorn calculus. It was managed with an open pyelolithotomy, and the patient had no intraoperative or postoperative complications.
UNASSIGNED: Staghorn stones can be complete or partial and often naturally progress to renal impairment. Thus, an aggressive therapeutic approach is crucial, with careful evaluation of the site and size of the stone, the patient\'s preference, and the institutional capacity. Ideally, staghorn calculi are completely removed, and it is imperative that the functions of the affected kidney are preserved as far as possible and when applicable. Although percutaneous nephrolithotomy is recommended for the removal of staghorn stones, several clinical, technical, and socioeconomic factors contributed to the use of open pyelolithotomy in the management of the case discussed here.
UNASSIGNED: Open pyelolithotomy can prove highly effective in removing large stones intact and in a single setting, the importance of which was accentuated by its unique clinical presentation and pathological anomalies.

We here report a rare case of congenital megapolycalicosis in a 14-year-old girl complicated by a 24-mm staghorn stone and numerous calculi at the level of all caliceal groups that had become symptomatic in recent weeks with malaise, hematuria, and urinary tract infection. Among the various therapeutic options, we opted for open surgery. The staghorn stone was removed by pyelotomy, and washout of the caliceal cavities released numerous microcalculi of 1.5-9 mm in size that were then removed. To our knowledge, this is the first case of pediatric megacapolycalicosis complicated by staghorn stone, which presents complex problems for the diagnosis and therapy.

UNASSIGNED: With the strong development of percutaneous nephrolithotomy as well as other less invasive procedures, the indication of open surgery for the treatment of nephrolithiasis has been significantly reduced and is only applied in selective cases.
METHODS: A 55-year-old male was admitted to the Department of Urology due to fever and left flank pain. Clinical examination and imaged studies reveal staghorn calculi in the right kidney and infected hydronephrosis with multiple stones on the left side. The stone removal surgery was performed in 2 sessions, left first - right after. The two operations came out with no peri- or post-operative complication, no blood transfusion.
UNASSIGNED: The two reasons for the indication of open surgery instead of percutaneous nephrolithotomy were i/ the stone\'s sizes were very large and very hard, and ii/ the multi-tract nephrolithotomy increased the risks of blood transfusion and parenchymal\'s damage. Also, a long-time and difficult nephroscopy was not the good choice for the left-infected hydronephrosis.
CONCLUSIONS: Open stone surgery is still a good alternative approach for kidney complex stone burden, especially infected hydronephrosis.

UNASSIGNED: Xanthogranulomatous pyelonephritis (XGP) is a rare and intense type of chronic kidney infection characterized by subversion of the renal tissue and its replacement by lipid- laden macrophages. XGP combined with emphysematous pyelonephritis(EPN) is rare and up until now only 7 cases with these presentations have been reported; so abundant clinical skills and appropriate radiographic imaging is required to reach the correct diagnosis. In this report, we present a case with two uncommon variants of pyelonephritis.
UNASSIGNED: A 55-year-old female presented with a history of type 2 diabetes mellitus, and a stroke leading to a left-sided hemiplegia state for 7 years, coronary artery bypass grafting(CABG), hypertension(HTN) , seizure, progressive fatigue, loss of appetite , fecal and urinary incontinence and right costovertebral angle tenderness. According to clinical signs, symptoms and documentation of gas within the renal parenchyma on computed tomography (CT) of abdomen, of EPN diagnosis was suggested; however histopathologic evaluation showed acute emphysematous pyelonephritis on chronic xanthogranulomatous pyelonephritis.
UNASSIGNED: EPN can emerge in a patient suffering from XPG which would add to the severity of the situation. In the case presented, concurrent underlying diseases such as diabetes mellitus, stroke, CABG, HTN along with severe fatigue and loss of appetite existed. Surgical treatment produces dramatic results.