Retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of stones in the horseshoe kidney; what are the advantages and disadvantages compared to each other?

Abstract

Introduction Kidney stones occur more frequently in patients with a horseshoe kidney (HSK) anomaly. Abnormal anatomy may make the stone removal procedures more difficult. Therefore we aimed to evaluate and compare retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) for the treatment of renal stones in the HSK anomaly. Material and methods In this descriptive study, patients with HSK anomaly who underwent RIRS and PCNL procedures were retrospectively evaluated. Demographic and renal stone characteristics, success and complications associated with the surgical methods were compared across patients. Results A total of 49 patients were evaluated, 28 underwent RIRS and 21 underwent PCNL. No differences were determined between the groups concerning the demographics of patients and stone characteristics. A single session and final stone-free rate was 71.4% and 85.7% in RIRS, 81% and 90.5% in PCNL (both p ≥0.05). However, RIRS had more re-treatment rate, while its mean length of hospital stay was shorter than PCNL (p = 0.035, p = 0.001). While no differences were detected between the associated complication rates, more of the complications encountered in the PCNL group were of a serious nature. Conclusions In the HSK anomaly, renal stones can be treated with RIRS and PCNL procedures with high success. With its minimal morbidity, low complication rates and the minor character of the associated complications, the RIRS procedure can sometimes be preferred to avoid complications related to PCNL in HSK anomaly with big sized kidney stones.

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

“…PCNL and URS have been widely investigated for the treatment of kidney stones in the HSK population. Kartal et al investigated 49 patients with HSK submitted to URS ( n = 29) and PCNL ( n = 21) [ 73 ]. A single session and final SRF were registered in 71.4% and 85.7% in URS, and 81% and 90.5% in PCNL groups, respectively (all p > 0.05).…”

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

“…Another recent study compared retrograde endoscopic treatment (fURS-RIRS) and percutaneous nephrolithotomy (PCNL) in treating renal lithiasis associated with horseshoe kidneys. The study followed 49 patients who received both treatments, with 21 undergoing PCNL and 28 RIRS [ 28 ]. Although the stone-free rates were comparable for both methods, the postoperative complications and perioperative morbidity associated with PCNL were much lower compared to fURS, considering it a viable option for these patients.…”