Effect of simple malrotation on percutaneous nephrolithotomy: a matched pair multicenter analysis

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Kidney stone management often involves percutaneous nephrolithotomy (PCNL).
• Anatomical variations like malrotated kidneys may pose challenges for PCNL.
• Comparative outcome data for PCNL in malrotated versus normal kidneys is limited.

Purpose of the Study:

• To compare the outcomes of percutaneous nephrolithotomy (PCNL) in patients with malrotated kidneys versus those with normally oriented kidneys.
• To assess the safety and efficacy of PCNL in the context of renal malrotation.

Main Methods:

• A multicenter, matched-pair study comparing 44 patients with malrotated kidneys (group 1) to 44 patients with non-malrotated kidneys (group 2).
• Operative and postoperative data were collected and analyzed using statistical tests (chi-square, Student t, Fisher exact).
• Key metrics included access attempts, fluoroscopy time, hemoglobin decrease, transfusion rates, and procedure success rates.

Main Results:

• Groups were similar in demographics and stone characteristics due to matched pairing.
• No significant differences were observed in multiple access attempts or fluoroscopy time between groups.
• While hemoglobin decrease was greater in the malrotated kidney group, blood transfusion rates were similar. Procedure success rates were comparable (77.3% vs. 79.5%).

Conclusions:

• Percutaneous nephrolithotomy (PCNL) is a safe and effective procedure for treating kidney stones in patients with malrotated kidneys.
• Renal malrotation does not significantly impede the success or safety of PCNL compared to normally oriented kidneys.
• These findings support the use of PCNL as a viable option for stone removal in patients with this anatomical variation.