Urolithiasis in the horseshoe kidney: a single‐centre experience

Abstract

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.

Outcome of Percutaneous Nephrolithotomy in Horseshoe Kidneys

“…jlmc.edu.np by Symons SJ et al [21] The mean stone burden was 385mm 2 (SD=331.8, range 125-1325) and the mean operating time from puncture to the completion of the procedure was 70.3 minutes (SD=25.3, range 46-138 )…”

“…Moreover, the nephroscope lies in alignment with the long axis of the kidney making easy access to the upper calyces, renal pelvis, lower calyces, pelviureteric junction and upper proximal ureter minimising the nephroscope torque on renal tissue. [20,21] In our study, we had upper pole calyceal access in 10 renal units and mid calyceal access in two renal units without any pleural and bowel injury. Though CT scan abdomen was recommended by Al-Otaibi in every case before surgery due to abnormal relationship with other viscera, we had done CT abdomen in only six cases (seven renal units) from 2015.…”

Flexible ureterorenoscopy in position or fusion anomaly: Is it feasible?

“…Its greater deflection capacity (up to 270°), coupled with progressively thinner laser fibers and the development of nitinol stone extractors have allowed the access and treatment of stones located in lower calyces or erratically-positioned calyces, leading to stone-free rates ranging from 70 to 88.2% in up to 1.5 sessions for stones < 30 mm in diameter. [25][26][27][28] Techniques such as reallocation of stones from the lower calyx to the middle or upper calyx aid in the success of the procedure by facilitating fragmentation, as well as increasing the useful life of the apparatus by avoiding excessive use of deflection. For cases with residual calculi, ESWL, PCNL or another F-URS session can be performed, but conservative treatment should not be ruled out when possible.…”

The success of extracorporeal shock wave lithotripsy at stones up to 10 mm in horseshoe kidneys

“…After SWL, stones in abnormal kidneys started to be treated mainly with this method [6][7][8][9][10]. With developing technology, treatments such as percutaneous nephrolithotomy (PCNL) [14], minimal PCNL [15], flexible URS [16] and laparoscopic approaches [17] started to be applied to abnormal kidneys.…”