Laparoscopy-assisted transperitoneal percutaneous nephrolithotomy for recurrent calculus in isthmic calix of...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Horseshoe kidney (HSK) urolithiasis presents management challenges, particularly for stones in the isthmic calix.
• Standard treatments like percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (SWL) have limitations for these specific calculi.
• The isthmic calix is often inaccessible with rigid PCNL and yields suboptimal SWL results due to poor fragment evacuation.

Observation:

• A 59-year-old male with a history of HSK and prior stone treatments presented with recurrent isthmic calix calculi.
• Imaging confirmed a large, recurrent stone in the anteriorly directed isthmic calix of the HSK.
• The patient experienced right-sided lower abdominal pain and urinary infections.

Findings:

• A novel laparoscopy-assisted transperitoneal PCNL was performed for the HSK stone.
• Laparoscopy facilitated safe retraction of abdominal contents, enabling access to the HSK.
• Complete stone clearance was achieved in a single procedure with fluoroscopic and laparoscopic guidance.

Implications:

• This case report introduces a potentially effective new surgical technique for treating complex urolithiasis in horseshoe kidneys.
• Laparoscopy-assisted PCNL may overcome the limitations of traditional methods for isthmic calix stones.
• The described approach offers a promising solution for achieving complete stone removal in challenging HSK anatomies.