[Clinical study on two surgical approaches to treatment of horseshoe kidney]

To compare the clinical effects of two surgical approaches to treatment of horseshoe kidney.

From January 1965 to December 1982, 15 patients (11 males, 4 females; aged 14 months to 59 years with a median of 31 years) with horseshoe kidney underwent surgical treatment by the waist cretroperitoneal approach (the waist-approach group). The clinical symptoms and signs were as follows: pain in the waist and abdomen (12 patients), hematuria (7), urinary frequency (4), gastrointestinal disorder (3), and abdominal masses (2). The urography revealed urinary calculus in 10 patients, hydronephrosis in 3, renal cyst in 1, pyonephrosis in 1, renal tuberculosis in 1, and renal cell carcinoma in 1. From January 1977 to December 2005, 17 patients (15 males, 2 females; aged 11 months to 56 years with a median of 29.4 years) with horseshoe kidney underwent surgical treatment by the epigastric transperitoneal approach (the abdomen-approach group). The clinical symptoms and signs were as follows: pain in the waist and abdomen (15 patients), hematuria (12), urinary frequency (10), gastrointestinal disorder (9), and abdominal masses (7). The urography revealed urinary calculus in 12 patients, hydronephrosis in 10, renal cyst in 3, renal tuberculosis in 1, renal cell carcinoma in 1, and congenital spinal bifida in 1. The two surgical approaches were compared in the clinical therapeutic effects.

There were no statistically significant differences in operating time, blood loss during operation, and the hospitalization after operation between the waist-approach group and the abdomen-approach group (129.59 +/- 23.25 min vs. 163.80 +/- 36.25 min; 495.29 +/- 87.20 ml vs. 553.00 +/- 92.27 ml; 13.17 +/- 1.14 d vs. 13.75 +/- 0.21 d; P > 0.05). The postoperative follow-up for 7 months to 6 years in 11 patients in the waist-approach group and in 6 patients in the abdomen-approach group revealed that there were statistically significant differences in postoperative complication and the recurrence rate of the renal calculus between the two groups (11.76%, 2/17 vs. 26.67%, 4/15; 33.33%, 5/15 vs. 0, 0/17; P < 0.05). The urography or CT taken 6 months to 2 years after operation in 4 patients in the waist-approach group and in 10 patients in the abdomen-approach group revealed that there was a significant improvement in hydronephrosis when compared with before operation.

Compared with the waist approach,the abdomen approach is a safer and more effective surgical treatment of horseshoe kidney.