Laparoscopic Heminephrectomy of Chronically Obstructed Horseshoe Kidney Moiety with Staghorn Calculus, Massive Pyonephrosis, and Xanthogranulomatous Pyelonephritis

Abstract

Laparoscopic heminephrectomy was performed in a 64-year-old woman with a chronically obstructed horseshoe kidney moiety. More than 3000 cc of pyonephrosis was drained through two percutaneous nephrostomy tubes for infection control before left moiety laparoscopic resection. This case report attests to the feasibility of laparoscopic resection of a massively obstructed horseshoe kidney when performed in a staged manner after prolonged drainage. Since an incision was required for removal of the large specimen, ligation of the horseshoe isthmus was completed through the same incision after hilar control and laparoscopic mobilization of the moiety were completed.

Horseshoe Kidney Complicated by Xanthogranulomatous Pyelonephritis in a Young Girl: A Case Report and Review of the Literature

“…The combination of HSK and XGP is extremely rare and the first case was reported in 1994 by Hammadeh et al (5). There have been only 7 cases reported in the English literature so far (5)(6)(7)(8)(9)(10)(11). The detailed characterization of all cases is presented in Table 1.…”

A Review of Rare Associations of Horseshoe Kidney: Highlight of a Rare Clinical Case of Polycystic Horseshoe Kidney, Liver Cyst, and Uterine Prolapse

“…xanthogranulomatous pyelonephritis and renal calculi, 9 emphysematous pyelonephritis and ureteric stones, 10 and pyonephrosis and xanthogranulomatous pyelonephritis. 6 The latter two cases of horseshoe kidney and pyelonephritis were managed with antibiotics, percutaneous drainage, and ureterolithotripsy, 10 and antibiotics, percutaneous drainage, and laparoscopic heminephrectomy, respectively. 6 Emphysematous pyelonephritis is a severe acute necrotising fasciitis of the renal parenchyma.…”

“…6 The latter two cases of horseshoe kidney and pyelonephritis were managed with antibiotics, percutaneous drainage, and ureterolithotripsy, 10 and antibiotics, percutaneous drainage, and laparoscopic heminephrectomy, respectively. 6 Emphysematous pyelonephritis is a severe acute necrotising fasciitis of the renal parenchyma. The most common risk factor is diabetes (for 80% of cases) followed by obstruction from urolithiasis.…”

“…Horseshoe kidney is usually asymptomatic but association with ureteropelvic junction obstruction, infection, and urolithiasis has been frequently reported, 6 and other rare associations including polycystic horseshoe kidney, malignancies, and vascular anomalies have been reported. The incidence of renal pelvis cancer associated with horseshoe kidney has been estimated at 19.8%, 2 and renal cell carcinoma has accounted for approximately 50.0% of malignancies found in horseshoe kidney.…”