Percutaneous nephrolithotomy (PCNL) in horse shoe kidneys

Area of Science:

• Urology
• Nephrology
• Surgical Procedures

Background:

• Horse shoe kidneys (HSK) present unique anatomical challenges for stone removal.
• Percutaneous nephrolithotomy (PCNL) is a standard treatment for kidney stones.

Purpose of the Study:

• To evaluate the safety and efficacy of PCNL in patients with calculi in horse shoe kidneys.
• To assess the stone clearance rate and complication profile of PCNL in HSK.

Main Methods:

• Retrospective review of 16 PCNL procedures performed on 14 patients with HSK and calculi between June 2001 and January 2005.
• Patient age ranged from 4 to 52 years, with a mean stone burden of 820 mm2.
• Access was typically gained via the upper pole (80%) in the prone position.

Main Results:

• Primary PCNL achieved stone clearance in 12 kidneys (75%).
• Secondary procedures (re-look PCNL, ESWL) improved the overall stone clearance rate to 93.7%.
• Complications included transient pyrexia (21%) and one case of ureteral stone fragment with leakage (7%), managed conservatively. No bleeding or wound infection occurred.

Conclusions:

• PCNL is a safe and effective treatment for kidney stones in horse shoe kidneys.
• The procedure does not carry a higher risk compared to PCNL in normal renal anatomy.
• High stone clearance rates (93.7%) with minimal complications make PCNL a valuable option for HSK.