OBJECTIVE To report the operative management and subsequent stone‐free rates of patients with urolithiasis in a horseshoe kidney and treated at one centre. PATIENTS AND METHODS We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 15‐year period. The stone burden, surgical management, complications and stone clearance rates were recorded. RESULTS In all, 55 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 60 renal units in 47 patients. Five patients had extracorporeal shock wave lithotripsy (ESWL), two had flexible ureteroscopy and one had a laparoscopic pyelolithotomy for a stone extending into the isthmus. PCNL was used for large stones (mean digitized surface area = 614.32 mm2) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures, completely cleared in two‐thirds of patients treated by ESWL, and in both who had flexible ureteroscopy and the one treated with laparoscopic pyelolithotomy. Complications were minimal, with 15% minor and 3% major complications in the PCNL group only. CONCLUSION Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.

Objective: To assess the technical difficulties, associated complications and stone clearance rates in patients with spinal neuropathy undergoing percutaneous nephrolithotomy. Methods: Twenty-nine patients with spinal neuropathy underwent percutaneous nephrolithotomy in the two centers studied between October 1995 and January 2002. They were nine patients with traumatic spinal cord injury, 10 patients with spina bifida and 10 with other heterogeneous causes for their spinal neuropathy. The group included 12 men and 17 women, with an average age of 44 years (14-80). Patients' medical records were reviewed retrospectively for data relating to their renal lithiasis. Results: A total of 39 percutaneous nephrolithotomy procedures were undertaken on 32 kidneys. Thirteen procedures were for staghorn calculi. Preoperatively, eight kidneys required nephrostomy and 5 J stent decompression. The average American Society of Anesthesiologists (ASA) score was 3, and one patient had percutaneous nephrolithotomy performed under local anaesthetic as the risk of general anaesthetic was felt to be too high. The associated morbidity and mortality in this group is significant. There were two postoperative deaths. Major complications were associated with three procedures, and consisted of seizures, aspiration pneumonia and pressure necrosis. Nine patients experienced minor complications including fever, hypotension and nephrostomy site leakage. Nine patients required intensive therapy unit care postoperatively and the average hospital stay for the group was 13.32 days. Only 18 (62%) patients were rendered stone-free from their initial percutaneous nephrolithotomy. Seven patients required a further procedure for stone clearance: four underwent extracorporeal shock-wave lithotripsy, two ureteroscopy and one nephrectomy. Conclusions: Patients with spinal neuropathy and renal lithiasis pose a significant operative challenge. Technical difficulties and potential complications should be considered carefully before undertaking percutaneous nephrolithotomy in these patients.

Laparoscopic pyeloplasty is a safe and effective management option for UPJO with excellent short-to medium-term results. It is a versatile operation, applicable to most cases of UPJO. Laparoscopic pyeloplasty has now superceded open surgery in our center as the gold standard surgical management for UPJO.

Laparoscopic reconstructive surgery for managing benign distal ureteral strictures is both safe and effective. Although open surgery currently remains the gold standard for these patients, all operative steps can be replicated laparoscopically, and this may become the future standard treatment.

age 5.9 [4.4] years) and group B of 562 adults (mean [ SD ] age 40.9 [13.1] years). The number and energy of SWs used was not predetermined and was tailored until adequate fragmentation was achieved. Initial stone reassessment was performed at 48 h and monthly thereafter. The number of SWs, intensity of SWs, stone-free rate, auxiliary procedure rate, re-treatment rate, complication rate and effectiveness quotient (EQ) were assessed in each group. RESULTSThe stone-free rate with ESWL was 84% in children and 87% in adults ( P = 0.78). The EQ was 77% and 75% in children and adults, respectively ( P = 0.56). The mean ( SD ) number of SWs and energy required per session was 950 (349) and 11.83 (0.48) kV in children and 1262 (454) and 12.36 (0.34) kV in adults ( P < 0.001). The re-treatment, auxiliary procedure and complication rates were similar in both groups. CONCLUSIONESWL is as safe and effective in children as in adults for solitary renal and upper ureteric stones that are < 2 cm. Children required significantly fewer and lower energy SWs to achieve equivalent results. KEYWORDS adult, children, ESWL, urolithiasisStudy Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo compare the outcome, safety and efficiency of extracorporeal shock wave lithotripsy (ESWL) using an electromagnetic lithotripter for upper urinary tract stones in children and adults. PATIENTS AND METHODSWe retrospectively reviewed data over a 5-year period for patients with solitary, renal and upper ureteric stones measuring < 2 cm in whom ESWL was the treatment method. Group A consisted of 44 children (mean [ SD ]