THE GIANT STAGHORN CALCULUS: ANESTHETIC IMPLICATIONS IN DEVELOPING HEALTHCARE SETTING

Abstract

The giant staghorn calculus represents a serious form of kidney stone disease characterized by the presence of large, bifurcating calculi that occupy the renal pelvis and extend into multiple calyces, resembling the antlers of a stag. Giant staghorn calculi may remain asymptomatic for prolonged periods, and if left untreated can lead to progressive kidney damage, loss of kidney function and life-threatening complications such as urosepsis. Thus, managing a patient with such an extraordinary and advanced renal pathology in a resource-constrained healthcare setting unfolds clinical and anesthetic challenges that demand vigilance and flexibility. We present the case of a 62-years-old male from a rural village near a small city, with an impressive medical history of persistent nephrolithiasis that progressed for years, due to inconsistent follow-up caused by limited financial means. He underwent right nephrectomy for a massive staghorn calculus with negligible functional renal parenchyma. Given the patient’s compromised health status and the presence of a large, fully-configurated complete staghorn calculus, which posed a significant surgical challenge due to its sheer magnitude, it was evident that potential anesthetic risks included hemodynamic instability, sepsis, and altered drug metabolism. Nonetheless, a comprehensive preoperative evaluation, continuous intraoperative monitoring and readiness for rapid intervention ensured a stable perioperative course without complications. Alongside the rarity of this pathology, this case highlights the critical role of anesthesiologists in anticipating and managing the complex challenges posed by such unique pathologies, demonstrating that meticulous planning and resilience enable the delivery of solid and life-sustaining care, even when presented with a narrow spectrum of choices.