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Published on: July 8, 2025
Percutaneous nephrolithotomy of kidney calculi in horseshoe kidney
Mohammad Reza Darabi Mahboub1, Maryam Zolfaghari, Ali Ahanian
1Department of Urology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. j_darabi@yahoo.com
Insights
Percutaneous nephrolithotomy (PCNL) is effective for treating kidney stones in horseshoe kidneys, achieving an 88.9% access rate and 66.7% stone-free status. Careful patient selection and surgeon experience are key for successful outcomes.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Horseshoe kidneys present unique anatomical challenges for treating kidney calculi.
- Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for kidney stone removal.
Purpose of the Study:
- To evaluate the efficacy and safety of PCNL in patients with horseshoe kidneys and calculi.
- To assess the feasibility of accessing the renal collecting system in horseshoe kidneys via PCNL.
Main Methods:
- A retrospective analysis of 9 patients with horseshoe kidneys who underwent PCNL between 1995 and 2005.
- Preoperative imaging included ultrasonography, plain abdominal radiography, and intravenous urography (IVU).
- Access to the collecting system was guided by fluoroscopy, followed by pneumatic or ultrasonic lithotripsy for stone fragmentation and removal.
Main Results:
- Successful access to the renal collecting system was achieved in 88.9% of patients.
- Complete or partial stone removal was accomplished in all patients, with 66.7% achieving stone-free status post-procedure.
- Two patients had residual calculi requiring further treatment with extracorporeal shockwave lithotripsy.
Conclusions:
- PCNL is a viable treatment option for kidney stones in horseshoe kidneys, comparable to patients with normal anatomy.
- Appropriate patient selection and surgeon expertise are crucial for optimizing PCNL outcomes in this patient cohort.
- Accessing the lower calyx in horseshoe kidneys poses a greater technical challenge due to anatomical variations.
Introduction:
The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in horseshoe kidneys with calculi.
Materials And Methods:
Between 1995 and 2005, we performed PCNL in 9 patients with horseshoe kidney. In 3 of them, there was a single calculus and the rest had multiple calculi in the pelvis and at least 1 in the calyxes. Ultrasonography, plain abdominal radiography, and intravenous urography (IVU) were performed in all patients. We used fluoroscopy for entering the system and then, pneumatic or ultrasonic lithotripsy was used.
Results:
In all except 1 patient (88.9%) we could access the system. Single calculi in 3 patients were removed. In 5 patients with multiple calculi, the calculus causing obstruction was removed, and in 3, the calculi located in the calyxes were removed too. Consequently, 66.7% were stone-free at the end of the procedure. In 2 patients, there were residual calculi in the calyxes and they underwent candidates for extracorporeal shockwave lithotripsy.
Conclusion:
Percutaneous nephrolithotomy can be used in patients with horseshoe kidney if the patient selection is appropriate and the surgeon is experienced enough. The success rate and complications are the same as the patients with normal anatomy. However, access to the lower calyx is more difficult due to its anatomic status.
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