A 48-year-old woman presents with recurrent urinary tract infections and dull left flank ache for one year. Plain X-ray KUB and CT show a large branching calculus filling the left renal pelvis and extending into all major calyces. Urine culture grows Proteus mirabilis. What is the definitive treatment of choice?
- A Extracorporeal shock wave lithotripsy alone
- B Open anatrophic nephrolithotomy
- C Percutaneous nephrolithotomy ✓
- D Ureteroscopic lithotripsy with laser fragmentation
Correct answer: C. Percutaneous nephrolithotomy
Explanation
A complete staghorn calculus is composed of struvite (infection stone) associated with urease-producing organisms such as Proteus. Left untreated it leads to progressive renal destruction and sepsis, so active removal is indicated. Percutaneous nephrolithotomy is the standard first-line modality because it achieves the highest stone-free rate for large branched calculi; ESWL alone is inadequate as monotherapy for complete staghorn stones, and open surgery is now reserved for cases where PCNL fails.
Reference: Campbell-Walsh-Wein Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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