Laparoscopic Nephrolithotomy in a Horseshoe Kidney.

Area of Science:

• Urology
• Surgical Innovation
• Congenital Anomalies

Background:

• Horseshoe kidney (HSK) is a common congenital renal fusion anomaly affecting 0.25% of the population.
• HSK can lead to complications like urinary tract infections (UTIs), stone formation (nephrolithiasis), and obstruction.
• Nephrolithiasis occurs in 20% of HSK patients, frequently necessitating surgical intervention.

Observation:

• Traditional stone treatments like extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy have limited success rates and higher complication risks in HSK due to anatomical variations.
• A 61-year-old female patient presented with recurrent UTIs and was diagnosed with a right HSK featuring a large lower pole stone (35 mm) and multiple smaller stones, alongside severe hydronephrosis.
• The patient's complex stone burden and HSK anatomy presented a significant treatment challenge.

Findings:

• Laparoscopic nephrolithotomy was successfully performed on the patient with a large and multiple renal stones within the horseshoe kidney.
• The procedure effectively addressed the severe hydronephrosis and the complex stone burden.
• This case demonstrates the feasibility and success of laparoscopic surgery for treating large renal stones in HSK.

Implications:

• Laparoscopic nephrolithotomy represents a safe and effective alternative for managing complex renal stones in patients with horseshoe kidney.
• This approach may overcome the limitations of traditional methods in treating HSK-associated nephrolithiasis.
• Further research into minimally invasive techniques for HSK stone management is warranted to improve patient outcomes.