Percutaneous nephrolithotomy in horseshoe kidney: comparing ultrasound-guided access in flank position with...

We conducted this study to compare radiation-free US-guided percutaneous nephrolithotomy (PNL) in the flank position with conventional PNL in the prone position for the treatment of renal stones in patients with horseshoe kidneys. In a retrospective study, 14 HSK patients that were treated with conventional fluoroscopy-guided PNL in the prone position (group A) were compared with twenty-four HSK patients that were treated US-guided PNL in the flank position (group B). Data on baseline characteristics, percentage of successful entries, stone-free rate, duration of admission and complication rate were obtained from data registry. The average duration of the operation was 57.6 min in group B, which was statistically less than group A with 65.9 min (P = 0.001). Access time varied from 10 to 32.4 min (mean = 17.1 min) in group A and 5-29.5 min (mean = 10.9 min) in group B (P < 0.001). Access length had a significant relation to the surgery method so PNL with US-guided had less access length (P = 0.002). There was no significant relationship between the surgery guide and the residual stone rate (P = 0.6). Hemoglobin decrease (P = 0.5), hospitalization duration (P = 0.5) and need for blood transfusion (P value = 0.6) were not statistically different between the two groups. PNL with US guidance in flank position is a safe and effective technique in HSK patients and is associated with fewer complications than the traditional approach as well as reduced operating time, radiation exposure, and its complications.