Related Experiment Video
Updated: Apr 3, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Tailored minimally invasive management of complex calculi in horseshoe kidney
Jie Ding1, Yuanyuan Zhang2, Qifeng Cao1
1Urology Department, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (FURS), and percutaneous nephrolithotomy (MPCNL) offer effective treatments for horseshoe kidney (HK) stones. Tailoring the minimally invasive approach to individual stone characteristics ensures optimal outcomes in HK calculus management.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithiasis Management
Background:
- Horseshoe kidney (HK) anatomy presents unique challenges for treating renal calculi.
- Complex calculi in HK require tailored management strategies for effective stone clearance.
- Minimally invasive techniques are preferred for treating kidney stones in HK.
Purpose of the Study:
- To evaluate the clinical efficacy of extracorporeal shock wave lithotripsy (ESWL), minimally invasive percutaneous nephrolithotomy (MPCNL), and flexible ureteroscopy (FURS) for calculi in horseshoe kidneys.
- To compare the outcomes of different minimally invasive treatment modalities based on stone size and complexity in HK patients.
- To determine the optimal treatment strategy for various types of calculi within the horseshoe kidney.
Main Methods:
- Retrospective review of 62 horseshoe kidney patients treated between January 2005 and May 2014.
- Patients were treated with ESWL (solitary stones ≤ 1.5 cm), retrograde FURS (stones ≤ 2-3 cm), or MPCNL/MPCNL-FURS (staghorn or complex calculi ≥ 2 cm).
- Outcomes assessed included stone-free rates, operative time, and complications.
Main Results:
- ESWL achieved a 72.7% stone-free rate for small solitary stones (≤ 1.5 cm).
- Retrograde FURS yielded an 88.9% stone-free rate for stones ≤ 2-3 cm.
- MPCNL and MPCNL-FURS demonstrated high stone-free rates (89.5% and 92.9%) for complex calculi (≥ 2 cm), with MPCNL combined with antegrade FURS showing reduced tract number and hemoglobin drop but longer operative time compared to MPCNL alone.
Conclusions:
- Combination of MPCNL and antegrade FURS is a safe and effective treatment for staghorn or complex calculi (≥ 2 cm) in HK, offering reduced blood loss compared to MPCNL alone.
- Retrograde FURS is favorable for stones ≤ 2-3 cm in HK.
- ESWL is effective for small, solitary stones (≤ 1.5 cm) in HK, emphasizing the need for individualized treatment selection.
Objective:
Complex calculi in horseshoe kidney (HK) present a significant management challenge. Here, we report the clinical efficacy of extracorporeal shock wave lithotripsy (ESWL), minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS), combined with holmium laser lithotripsy, in the treatment of calculi in HK.
Methods And Results:
From January 2005 to May 2014, 62 HK patients with renal calculi were reviewed in terms of medical history, treatment modality and therapeutic outcome in a single tertiary care hospital. Among the patients, 11 with a solitary stone ≤ 1.5 cm in diameter received ESWL, leading to overall stone-free rate of 72.7%; 18 with stone diameter ≤ 2-3 cm received retrograde flexible ureteroscopy, with a recorded mean digitized surface area (DSA) of 339.6 ± 103.9 mm2, mean operation time of 93.1 ± 11.5 minutes and overall stone-free rate of 88.9%; and 33 with staghorn or complex calculi (d ≥ 2 cm) had MPCNL or MPCNL-FURS, with a recorded mean DSA of 691.0 ± 329.9 vs. 802.9 ± 333.3 mm2, mean operation time of 106.4 ± 16.6 vs. 124.4 ± 15.1 min and overall stone-free rate of 89.5% vs. 92.9%. For complex calculi (d ≥ 2 cm), MPCNL combined with antegrade FURS was superior in terms of reducing number of tracts, controlling mean hemoglobin drop, but required longer operation time, comparing with MPCNL alone.
Conclusions:
As minimally invasive treatments, a combination of MPCNL and antegrade FURS provides a safe and effective modality in the management of staghorn or complex calculi (d ≥ 2 cm) in HK with significantly reduced blood loss comparing to MPCNL alone, and retrograde FURS alone is favorable for stones with a diameter ≤ 2-3 cm. ESWL is effective for viable small solitary stones (d ≤ 1.5 cm). Treatment modality should be tailored based on individual condition.
More Related Videos
06:39Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
Published on: November 22, 2019
05:34A Mouse Model to Evaluate the Long-Term Structural and Functional Outcomes after the Reversal of Prolonged Unilateral Ureteric Obstruction
Published on: July 18, 2025
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:30Urinary Tract Calculi III: Medical Management
01:28Urinary Tract Calculi V: Nursing Management
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:28Urinary Tract Calculi I: Introduction
01:28Chronic Kidney Disease III: Interprofessional Care