Percutaneous treatment of patients with calculi in a horseshoe kidney can be challenging due to the altered anatomical relationship in the retroperitoneum. Therefore, we performed a multi-institutional review to assess the safety and efficacy of this minimally invasive technique.
Materials and Methods:
Of 37 patients identified with calculi in a horseshoe kidney at 3 institutions 24 (65%) underwent percutaneous nephrolithotripsy as primary treatment. Average patient age was 48.4 years and 75% of the patients were male. In 3 patients with staghorn calculi mean stone size as measured by computed digitized stone surface area was 448 mm2. Mean followup was 5.8 months. The stone-free rate, complication rate, need for secondary intervention and stone composition were evaluated.
Renal access was obtained through an upper pole calix in 63% of the cases, a lower calix in 25% and a middle calix in 4%. Access location was not documented in 1 patient (4%). Of the 24 patients 21 (87.5%) were rendered stone-free after primary or second look procedures. Flexible nephroscopy was used in 84% of cases. Minor complications occurred in 4 patients (16.7%), whereas 3 (12.5%) experienced major complications, including significant bleeding necessitating early cessation, nephropleural fistula and pneumothorax. No deaths occurred as a result of this treatment choice. Stone analysis was available for 21 cases (87.5%). Calcium stones predominated (87.5%), followed by uric acid (9.5%) and struvite (4.8%).
Percutaneous treatment of patients with renal calculi in a horseshoe kidney is technically challenging, usually requiring upper pole access and flexible nephroscopy due to the altered anatomical relationships of the fused renal units. The success rate based on stone-free results and a relatively low incidence of major complications suggest that this minimally invasive management option is an effective means of stone management in this complex patient population.
- 1 : Horseshoe kidney and urolithiasis. J Urol1981; 125: 620. Link, Google Scholar
- 2 : Horseshoe kidneys: a 40-year experience. J Urol1975; 113: 743. Link, Google Scholar
- 3 : The horseshoe kidney: therapeutic considerations with urolithiasis. J Endourol1989; 3: 51. Google Scholar
- 4 : ESWL as the treatment for lithiasis in horseshoe kidney. Eur Urol1991; 20: 122. Google Scholar
- 5 : Effectiveness of extracorporeal shockwave lithotripsy in the management of stone-bearing horseshoe kidneys. J Endourol1996; 10: 13. Google Scholar
- 6 : Effectiveness of extracorporeal shockwave lithotripsy in the management of stone-bearing horseshoe kidneys (editorial comment). J Urol1998; 160: 1949. Google Scholar
- 7 : Extracorporeal shock wave lithotripsy in ureteral and kidney malformations. Urol Int2001; 66: 61. Google Scholar
- 8 : Stones in horseshoe kidneys: results of treatment by extracorporeal shock wave lithotripsy and endourology. J Urol1991; 146: 1213. Link, Google Scholar
- 9 : Retrograde renal pelvic access sheath to facilitate flexible ureteroscopic lithotripsy for the treatment of urolithiasis in a horseshoe kidney. J Urol2000; 164: 1290. Link, Google Scholar
- 10 : Current management of calculi in horseshoe kidneys. Scand J Urol Nephrol2000; 34: 114. Google Scholar
- 11 : Percutaneous stone removal in horseshoe kidney. Urology1986; 28: 41. Google Scholar
- 12 : Percutaneous nephrolithotripsy in horseshoe kidney. Urology1987; 29: 115. Google Scholar
- 13 : Percutaneous nephrolithotomy in horseshoe kidneys. Applied anatomy and clinical experience. Br J Urol1988; 62: 117. Google Scholar
- 14 : Percutaneous nephrolithotomy for calculi in horseshoe kidneys. J Urol1991; 145: 481. Link, Google Scholar
- 15 : Horseshoe kidney: the impact of percutaneous surgery. Eur Urol1992; 21: 134. Crossref, Medline, Google Scholar
- 16 : Urolithiasis in horseshoe kidneys: therapeutic management. Urology1996; 47: 182. Crossref, Medline, Google Scholar
- 17 : Supracostal percutaneous nephrolithotomy for upper pole caliceal calculi. J Endourol1998; 12: 359. Google Scholar
- 18 : Percutaneous stone removal in horseshoe kidneys. J Urol1999; 162: 674. Link, Google Scholar
- 19 : Percutaneous operative procedures in horseshoe kidneys. J Urol1999; 161: 371. abstract 1436. Google Scholar
- 20 : Critical analysis of supracostal access for percutaneous renal surgery. J Urol2001; 166: 1242. Link, Google Scholar
From the Division of Urology, Duke University Medical Center (GVR, BKA, AZW, GMP), Durham, North Carolina, Department of Urology, University of Western Ontario (JDD, JDW, DTB), London, Ontario, Canada, and Department of Urology, Wake Forest University School of Medicine (DGA), Winston-Salem, North Carolina