Ureteroscopic management of stones in anomalous kidneys

Surgical management of stones in anomalous kidney presents a problem for urologic surgeons. Various minimally invasive management options have been previously reported including shock wave lithotripsy (SWL), percutanteous nephrolithitomy (PNL), as well as ureteroscopy. While all of their techniques work well in select populations, recent improvements in endoscopic technology and intracorporeal lithotripsy make ureteroscopy possible for most cases of stones in ectopic, pelvic, or transplant kidneys. Additionally, many of the limitations of shock wave lithotripsy and/or percutaneous neprholithotomy can be overcome with a ureteroscopic approach. As new endoscopic technology and adjunctive device developments continue to enter the urologist's armamentarium the role of ureteroscopy continues to expand. Once unapproachable stones may now be addressed via flexible ureteroscopes, improved baskets, and holmium lasers. In conclusion ureteroscopic management of urolithiasis in anomalously located kidneys is a viable approach. Success rates are similar to those reported for SWL and the morbidity is less than PNL. With increasing dissemination of ureteroscopic skills, improved technology and enhanced adjunctive devices (i.e.; sheaths and baskets), ureteroscopy should play a larger role in the management of these challenging patients, with subsequently reduced patient morbidity.