<p>Laparoscopy-Assisted Transperitoneal Percutaneous Nephrolithotomy for the Treatment of Renal Stones in a Horseshoe Kidney</p>

Abstract

The objective of this case report is to highlight treatment by LAT-PCNL in a patient with horseshoe kidney. A 51-year-man with hematuria presented to the emergency department with moderate abdominal pain starting 7 hrs ago. He did not report a history of previous urological disease. Renal stone and horseshoe kidney malformation were diagnosed based on the plain abdominal film, intravenous urogram (IVU), non-contrast computed tomography (CT-IVU), and ultrasound findings. Due to the larger stone bulk and renal malformation, it was not possible to perform extracorporeal shock wave lithotripsy (ESWL) monotherapy or ESWL sandwich therapy. Moreover, since percutaneous nephrolithotomy (PCNL) had some challenges and limitations due to high skin-to-stone distance, special anatomy, dispersion stones, and possible consequent internal organs injuries, we performed LAT-PCNL on our patient. We did not observe any perioperative complication. Postoperative control abdominal x-ray revealed only a medium ureteral stone that was extracted while removing the Double-J stent a month later. The patient was discharged on the third postoperative day with normal laboratory values. At 3-month follow-up, the patient was stone-free with normal renal function and renal ultrasonography. Laparoscopy-assisted transperitoneal PCNL seems to be a safe and minimally invasive technique that can be used as an alternative approach in the management of renal stones in special cases of horseshoe kidneys.

Results of laparoscopic management of stones in horseshoe kidney at a tertiary referral hospital

“…(10) Haghighi et al described a case of laparoscopy-assisted transperitoneal percutaneous nephrolithotomy (LA-TPNL) with no fluoroscopy, considering it a useful and reliable surgery, with a short operative time. (11) We found transperitoneal LP to be an excellent option for treating renal pelvic stones in patients with horseshoe kidney. It is an alternative to different forms of endoscopic treatment, with a high stone-free rate, no radiation, short hospital stay, and a considerably short surgery duration in experienced hands, albeit operative time can be affected by the BMI of the patient.…”

Laparoscopy and ureteroscopy cooperative surgery for high burden stones in solitary kidney and ureter in one stage: A case report

“…The ESWL was usually applied to stones >2 cm, although this type of sandwich management is not often used now. For the treatment of high burden stones in the pelvic kidney or other renal anomalies (16), there have also been reports on the use of laparoscopy-assisted PCNL (LA-PNL) (18)(19)(20). The SFR of this method was found to be in the range 75-91% and no complications were reported.…”

Laparoscopy-Assisted Percutaneous Nephrolithotripsy (PCNL) in Ectopic Pelvic Kidney

“…In contrast to the normally structured kidneys, the management of nephrolithiasis in ectopic kidneys differs and there are no clear consensuses to the optimum approach [ 4 ]. Percutaneous nephrolithotripsy (PCNL) has been regarded as the favored modality in the treatment of stones that are larger than 2 cm in diameter [ 5 ]. However, this approach could carry a risk of injury to the surrounding vascular structures or adjacent organs, particularly the overlying bowels [ 5 ] when dealing with ectopic kidneys.…”

“…Percutaneous nephrolithotripsy (PCNL) has been regarded as the favored modality in the treatment of stones that are larger than 2 cm in diameter [ 5 ]. However, this approach could carry a risk of injury to the surrounding vascular structures or adjacent organs, particularly the overlying bowels [ 5 ] when dealing with ectopic kidneys. Thus, the use of a laparoscope to assist in the procedure provides a safe way of clearing the stone herein making this procedure a favored minimally invasive intervention for such cases.…”