Percutaneous nephrolithotomy in patients with kidney malformations

Percutaneous nephrolithotomy (PCNL) for complex calculi within malformed kidneys can be challenging because of the abnormal anatomy. We present our 7-year experience with PCNL in such patients.

We performed PCNL on 16 patients with complex calculi and anomalous kidneys, including 7 with horseshoe kidneys, 5 with rotation anomalies, 3 with ectopic kidneys, and 1 with a small kidney. After appropriate preoperative evaluation, the procedure was performed by choosing either anterior or posterior approaches depending on the kidney anomaly. When required, ultrasonography, laparoscopy, or both were used, as well as fluoroscopy to control the procedures.

A single-stage PCNL resulted in complete clearance in 13 patients (81%). A second-look procedure, alone or followed by shockwave lithotripsy, conferred stone clearance in one patient with a malrotated kidney and two with staghorn calculi in horseshoe kidneys. More than one tract was needed in two patients. The procedure was guided by laparoscopy in two patients with calculi in ectopic left kidneys. Serious complications were not encountered.

Patients with malformed kidneys and complex calculi can be managed safely and effectively with PCNL when they are properly selected and appropriately assessed before operation.