What is the treatment for large struvite stones?

• A. Extracorporeal shock wave lithotripsy
• B. Open surgical removal
• C. Ureteroscopic stone extraction
• D. Percutaneous nephrolithotomy with long-term prophylactic antibiotics

Answer: (D)

Large struvite stones are infection-related stones that often form bulky, branching “staghorn” calculi in the kidney. Because of their size and anatomy, they don’t respond well to simple fragmentation or minimally invasive methods alone. The most effective approach is percutaneous nephrolithotomy, which gives direct kidney access to remove the stone material efficiently, often in one or a few sessions, achieving complete clearance more reliably than other methods for large stones.

Because these stones are tied to infection, it’s essential to also address the underlying bacteria. After removing as much stone as possible, antibiotics guided by urine culture are used long-term to eradicate or suppress infection and prevent recurrence. Ensuring the urinary tract is infection-free after removal is a key part of preventing new stone formation.

Other options are less suitable for large struvite stones: extracorporeal shock wave lithotripsy tends to fail to clear staghorn stones effectively; ureteroscopic removal works best for smaller or more accessible stones; open surgical removal is much less common today due to higher morbidity.