What is the treatment for struvite renal calculi?

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Struvite stones form in urine infected with urease-producing bacteria, and they often grow into large, branching “staghorn” calculi that fill the renal pelvis and calyces. Clearing these large stone burdens is best achieved with percutaneous nephrolithotomy, which provides direct access to the kidney to remove substantial stone material in a single procedure and yields high stone-free rates. Noninvasive fragmentation methods like lithotripsy are less effective for large or complex stones and can leave residual fragments that continue to harbor infection. Ureteroscopy with laser is typically used for smaller or more favorably located stones, not large staghorn stones. Conservative management wouldn’t address the obstruction or ongoing infection risk. After stone removal, treating the infection and preventing recurrence are essential.