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Extracorporeal shock-wave lithotripsy in horseshoe kidneys
D R Locke1, R C Newman, G S Steinbock
1Department of Surgery, University of Florida, Gainesville.
Urology
|May 1, 1990
Summary
Extracorporeal shock-wave lithotripsy (ESWL) effectively treats kidney stones in horseshoe kidneys, often requiring ancillary procedures. This approach achieved stone-free status in 73% of treated renal units.
Area of Science:
- Urology
- Nephrology
- Medical Technology
Background:
- Horseshoe kidneys present unique anatomical challenges for treating renal calculi.
- Conventional extracorporeal shock-wave lithotripsy (ESWL) positioning can be difficult in these ectopic renal units.
Purpose of the Study:
- To evaluate the efficacy and necessity of ancillary procedures in conjunction with ESWL for calculi in horseshoe kidneys.
- To assess treatment outcomes for patients with renal stones in horseshoe kidneys.
Main Methods:
- Retrospective analysis of 10 patients (11 renal units) with horseshoe kidney calculi treated with Dornier HM-3 lithotriptor and ESWL.
- Inclusion of pre-ESWL manipulations (Double J stent, ureteral catheter, percutaneous nephrostomy) and "blast path" treatment for difficult positioning.
- Documentation of initial fragmentation, post-ESWL interventions, and final stone-free rates.
Main Results:
- Good initial stone fragmentation was achieved in 73% of renal units.
- 8 renal units (73%) were rendered stone-free after all procedures; 55% with ESWL alone.
- Two episodes of post-ESWL obstruction required intervention, necessitating multiple ancillary procedures in one patient.
Conclusions:
- ESWL is an effective treatment option for selected patients with calculi in horseshoe kidneys.
- Anatomical variations in horseshoe kidneys may require "blast path" targeting or prone positioning, alongside ancillary procedures.
- Careful patient selection and potential need for multiple interventions are crucial for successful ESWL outcomes in this cohort.
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