Struvite Stones

  • Walter P. MutterEmail author
Part of the Nutrition and Health book series (NH)


Struvite kidney stones are rare but may cause significant morbidity and mortality. Therapy remains primarily surgical, but combined treatment with antibiotics is now common. Pharmacologic dissolution therapy has been applied successfully, but the side effects of currently available drugs are significant, limiting their use. Struvite stones are strongly associated with genitourinary infection and urinary stasis, but metabolic abnormalities may coexist and formal metabolic evaluation may be useful in some cases. New treatments with a renewed emphasis on hybrid and non-surgical dissolution therapies are being investigated.


Struvite Infection stones Staghorn Urinary tract infection Magnesium ammonium phosphate Calcium carbonate apatite 


  1. 1.
    Griffith DP. Struvite stones. Kidney Int. 1978;13(5):372–82.PubMedCrossRefGoogle Scholar
  2. 2.
    Jaskowiec TC, et al. No stone unturned: the presence of kidney stones in a skeleton from 19th century Peoria, Illinois. Int J Paleopathol. 2017;19:18–23.PubMedCrossRefGoogle Scholar
  3. 3.
    Wall I, et al. Biochemical risk factors in patients with renal staghorn stone disease. Urology. 1986;28(5):377–80.PubMedCrossRefGoogle Scholar
  4. 4.
    Healy KA, Ogan K. Pathophysiology and management of infectious staghorn calculi. Urol Clin North Am. 2007;34(3):363–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Viprakasit DP, et al. Changing composition of staghorn calculi. J Urol. 2011;186(6):2285–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Resnick MI, Boyce WH. Bilateral staghorn calculi--patient evaluation and management. J Urol. 1980;123(3):338–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Preminger GM, et al. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005;173(6):1991–2000.PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen TD, Preminger GM. Struvite calculi. Semin Nephrol. 1996;16(5):425–34.PubMedGoogle Scholar
  9. 9.
    Bichler KH, et al. Urinary infection stones. Int J Antimicrob Agents. 2002;19(6):488–98.PubMedCrossRefGoogle Scholar
  10. 10.
    Rodman JS. Struvite stones. Nephron. 1999;81(Suppl 1):50–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Schwaderer AL, Wolfe AJ. The association between bacteria and urinary stones. Ann Transl Med. 2017;5(2):32.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Parkhomenko E, et al. A multi-institutional study of struvite stones: patterns of infection and colonization. J Endourol. 2017;31(5):533–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Singh P, et al. Stone composition among first-time symptomatic kidney stone formers in the community. Mayo Clin Proc. 2015;90(10):1356–65.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Flannigan R, et al. Renal struvite stones--pathogenesis, microbiology, and management strategies. Nat Rev Urol. 2014;11(6):333–41.PubMedCrossRefGoogle Scholar
  15. 15.
    Gnessin E, et al. Changing composition of renal calculi in patients with musculoskeletal anomalies. J Endourol. 2011;25(9):1519–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Akagashi K, et al. Characteristics of patients with staghorn calculi in our experience. Int J Urol. 2004;11(5):276–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Lingeman JE, Siegel YI, Steele B. Metabolic evaluation of infected renal lithiasis: clinical relevance. J Endourol. 1995;9(1):51–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Kristensen C, et al. Reduced glomerular filtration rate and hypercalciuria in primary struvite nephrolithiasis. Kidney Int. 1987;32(5):749–53.PubMedCrossRefGoogle Scholar
  19. 19.
    Diri A, Diri B. Management of staghorn renal stones. Ren Fail. 2018;40(1):357–62.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Blandy JP, Singh M. The case for a more aggressive approach to staghorn stones. J Urol. 1976;115(5):505–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Koga S, et al. Staghorn calculi--long-term results of management. Br J Urol. 1991;68(2):122–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Deutsch PG, Subramonian K. Conservative management of staghorn calculi: a single-centre experience. BJU Int. 2016;118(3):444–50.PubMedCrossRefGoogle Scholar
  23. 23.
    Iqbal MW, et al. Contemporary management of struvite stones using combined endourologic and medical treatment: predictors of unfavorable clinical outcome. J Endourol. 2016;30(7):771–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Williams JJ, Rodman JS, Peterson CM. A randomized double-blind study of acetohydroxamic acid in struvite nephrolithiasis. N Engl J Med. 1984;311(12):760–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Rodman JS, Williams JJ, Jones RL. Hypercoagulability produced by treatment with acetohydroxamic acid. Clin Pharmacol Ther. 1987;42(3):346–50.PubMedCrossRefGoogle Scholar
  26. 26.
    Pearle MS, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316–24.PubMedCrossRefGoogle Scholar
  27. 27.
    Iqbal MW, et al. Should metabolic evaluation be performed in patients with struvite stones? Urolithiasis. 2017;45(2):185–92.PubMedCrossRefGoogle Scholar
  28. 28.
    Chamberlin JD, Clayman RV. Medical treatment of a Staghorn calculus: the ultimate noninvasive therapy. J Endourol Case Rep. 2015;1(1):21–3.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Smith LH. New treatment for struvite urinary stones. N Engl J Med. 1984;311(12):792–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Sant GR, Blaivas JG, Meares EM Jr. Hemiacidrin irrigation in the management of struvite calculi: long-term results. J Urol. 1983;130(6):1048–50.PubMedCrossRefGoogle Scholar
  31. 31.
    Dretler SP, Pfister RC. Primary dissolution therapy of struvite calculi. J Urol. 1984;131(5):861–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Tiselius HG, et al. Minimally invasive treatment of infection staghorn stones with shock wave lithotripsy and chemolysis. Scand J Urol Nephrol. 1999;33(5):286–90.PubMedCrossRefGoogle Scholar
  33. 33.
    Houston DM, et al. A diet with a struvite relative supersaturation less than 1 is effective in dissolving struvite stones in vivo. Br J Nutr. 2011;106(Suppl 1):S90–2.PubMedCrossRefGoogle Scholar
  34. 34.
    Chauhan CK, Joshi MJ. Growth inhibition of struvite crystals in the presence of juice of Citrus medica Linn. Urol Res. 2008;36(5):265–73.PubMedCrossRefGoogle Scholar
  35. 35.
    Manzoor MAP, et al. Vitamin C inhibits crystallization of struvite from artificial urine in the presence of Pseudomonas aeruginosa. Int Braz J Urol. 2018;44(6):1234–42.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Thalji NK, et al. Enzymatic dissolution of calcium and struvite crystals: in vitro evaluation of biochemical requirements. Urology. 2011;78(3):721 e13–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of NephrologyNewton-Wellesley HospitalNewtonUSA

Personalised recommendations