[Classification of staghorn calculus disease of the kidney based on 105 personal cases and a review of the literature].

The majority of staghorn calculi (branched calculi)--25 per cent bilateral--is mainly composed of calcium phosphates, in about 2/3 with varying fractions of Struvite. Pure Struvite stones are rare. Large fractions of Struvite form a soft concrement. Infection with urea splitting bacteria arises ascending, therefore predominantly in female kidneys, except for the first decennium. Staghorn calculi without Struvite (1/3 of our cases), show extremely large growth and sterile urine. Some Struvite stones have sterile urine or Struvite without urea splitting bacteria. The shape of branched calculi depends on the form of hilus renalis and the aggressiveness of the alkaline urine and the infection. Renal cirrhosis--almost always present--follows bacterial or abacterial obstruction, depending on the degree of vascular obliteration by reactive fibrosis of the intima, with or without pyonephrotic, xanthomatous necrosis, similar to renal tuberculosis. The so-called "large stone kidney" is obstructive, aseptic and lipomatous special form of staghorn calculus and cirrhosis. Stone formation and grade of cirrhosis may be determined by tomography.