Urolithiasis in horseshoe kidney with duplex collecting system

Horseshoe kidney is a known congenital anomaly where the two kidneys are fused at their lower poles. This condition can lead to various complications, including the formation of kidney stones. While horseshoe kidney is often associated with other urinary tract anomalies, the combination with a duplex collecting system is rare. Prior research has shown that patients with horseshoe kidney are at increased risk for urolithiasis due to anatomical abnormalities. However, the presence of a concurrent partial duplex collecting system in such cases is not well documented. No prior work had resolved the diagnostic and procedural challenges posed by this rare combination. That uncertainty drove the need for a case report that highlights the anatomical complexity and surgical management. This gap motivated the authors to describe a unique clinical scenario involving a right partial duplex collecting system in a horseshoe kidney. The study contributes to the understanding of how to approach such cases in a single surgical session.

The aim of this study was to present a case of horseshoe kidney with a right partial duplex collecting system that was not identified on preoperative imaging. The authors sought to demonstrate the surgical approach used to manage this rare anatomical variation. They focused on the use of a prone-split leg position during percutaneous nephrolithotomy. This position allows for better access to both the upper and lower pole moieties of the kidney. The study aimed to show how this technique can facilitate the performance of both flexible ureterorenoscopy and percutaneous nephrolithotomy in one setting. The authors also intended to highlight the importance of intraoperative imaging for identifying unexpected anatomical variations. Their goal was to provide a practical example for urologists managing similar cases. The study emphasizes the need for tailored approaches in complex renal anomalies.

The authors used a combination of imaging and surgical techniques to address the case of horseshoe kidney with a partial duplex collecting system. Preoperative computed tomography failed to detect the right partial duplex collecting system. During the procedure, a prone-split leg position was employed to allow access to both the upper and lower pole moieties. Flexible ureterorenoscopy was performed on the lower pole moiety to remove stones. Simultaneously, percutaneous nephrolithotomy was used for the upper pole moiety. The use of this combined approach enabled the surgeons to complete the procedure in a single session. Intraoperative imaging was crucial for confirming the anatomy and guiding the interventions. The authors documented the steps taken to ensure complete stone clearance. The method highlights the importance of adapting surgical positioning to complex anatomical variations.

The surgical approach successfully achieved complete stone clearance in a single session. The prone-split leg position allowed access to both the upper and lower pole moieties of the horseshoe kidney. Flexible ureterorenoscopy was effective in treating the lower pole moiety. Percutaneous nephrolithotomy was used to remove stones from the upper pole moiety. The right partial duplex collecting system was not identified on preoperative imaging but was confirmed intraoperatively. The combined use of these techniques minimized the need for multiple procedures. The authors reported no intraoperative complications. The results demonstrate the feasibility of a single-stage approach for managing this rare anatomical variation.

The authors concluded that the use of a prone-split leg position facilitates the treatment of horseshoe kidney with a partial duplex collecting system. This approach allows for the simultaneous performance of flexible ureterorenoscopy and percutaneous nephrolithotomy. The study suggests that intraoperative imaging is essential for identifying anatomical variations not seen on preoperative scans. The results support the use of a combined surgical strategy in such cases. The authors propose that this method can reduce the need for multiple procedures. The case highlights the importance of adapting surgical techniques to complex anatomical conditions. The findings may guide future management of similar cases. The study emphasizes the value of a tailored approach in urological surgery.