Outcomes of ureteroscopy for stone disease in anomalous kidneys: a systematic review

Abstract

Introduction Treatment of stone disease in anomalous kidneys can be challenging. As ureteroscopy (URS) has advanced, the number of studies reporting on outcomes of URS for stone disease in anomalous kidneys has increased. Our objective was to perform a systematic review of the literature to evaluate the outcomes of URS for stone disease in this group of patients. Methods A Cochrane style review was performed in accordance with the PRISMA guidelines using Medline, EMBASE, CINAHL, Cochrane Library, Scopus and individual urologic journals for all English language articles between inception and June 2018. Results Fourteen papers (413 patients) with a mean age of 43 years and a male to female ratio of 285:128 were included. The underlying renal anomaly was horseshoe kidney (n = 204), ectopic kidney (n = 117), malrotation (n = 86), cross fused ectopia (n = 2) and others (n = 2). With a mean stone size of 16 mm (range 2-35 mm), the majority of stones were in the lower pole (n = 143, 34.6%) or renal pelvis (n = 128, 31.0%), with 18.9% (n = 78) having stones in multiple locations. Treatment modality included the use of flexible ureteroscope in 90% of patients and ureteral access sheath used in 11 studies. With a mean operative time of 61.3 min (range 14-185 min), the initial and final SFR was 76.6% (n = 322) and 82.3% (n = 340), respectively. The overall complication rate was 17.2% (n = 71), of which 14.8% were Clavien I/II and the remaining 2.4% were Clavien ≥ III complications. Conclusion Although ureteroscopy in patients with anomalous kidneys can be technically challenging, advancements in endourological techniques have made it a safe and effective procedure. In these patients the stone-free rates are good with a low risk of major complications.

Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

“…Anomalous kidneys arise from different abnormalities in the embryological development: abnormal ascent, fusion, rotation, or a combination of these. Anatomical anomalies not only lead to compromised renal drainage, but also increase the risk of urolithiasis [ 69 ].…”

Unfavorable factors in accessing the pelvicalyceal system during retrograde flexible ureteroscopy (fURS)

“…Multiple studies have evaluated the safety profile and success rates of the procedure in abnormal kidneys, and the findings consistently demonstrate low complication rates. However, the stone-free rate did not exceed 90% in nearly all cases [ 32 , 65 - 67 ]. A 2017 study by Ergin et al [ 68 ] assessed success rates (stone-free) in 101 patients with renal lithiasis and associated renal anatomical anomalies.…”

“…Although ureteroscopy may be difficult in these particular patients, a systematic review conducted in 2020 by Lisa Lavan et al [ 32 ] examined 117 cases of ectopic kidney along with other kidney anomalies and demonstrated that endourological technique advancements had made ureteroscopy an effective and safe procedure, combined with minimal rates of complications and promising postoperative stone-free status. A study conducted by Omer Faruk Bozkurt et al [ 33 ] investigated retrograde fURS management in 26 patients with renal lithiasis associated with ectopic kidneys [ 33 ].…”

Comparison of the Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy and Flexible Ureteroscopy for Treatment of Urolithiasis in Horseshoe Kidney Patients: A Systematic Review and Meta-Analysis

“…Surprisingly, not only no complications were observed, but also the efficacy of FURS was similar to PNCL. Lavan et al ( 27 ) published a more recent review on the outcomes of ureteroscopy for stone disease in anomalous kidneys, and they reported that patients who underwent FURS got good stone-free rates with a low risk of major complications, although the technic is challenging. This evidence indicated that SWL and FURS could be a feasible and safe alternative in patients with HK with calculus.…”