Supine mini percutaneous nephrolithotomy in horseshoe kidney

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) for horseshoe kidney (HSK) stones is typically done in the prone position.
• The safety and efficacy of the supine position for PCNL in HSK patients remain less understood compared to standard kidney anatomy.

Purpose of the Study:

• To evaluate the outcomes of PCNL in HSK patients treated in the supine position.
• To compare pre- and post-operative data, complications, and stone clearance rates across multiple institutions.

Main Methods:

• Retrospective analysis of 10 HSK patients undergoing PCNL in the supine position between 2017-2022.
• Assessment of pre- and post-operative renal function, stone characteristics, and complications using CT scans and the Clavien-Dindo grading system.
• Success defined as stone-free or ≤4 mm residual fragments (Clinically Insignificant residual Fragments - CIrF).

Main Results:

• A 100% overall success rate was achieved, with 90% of patients stone-free and 10% having CIrF.
• No intraoperative complications were recorded.
• Only one patient experienced a Clavien-Dindo Grade II post-operative complication (urosepsis), successfully treated with antibiotics.

Conclusions:

• Mini-PCNL in the supine position demonstrates a high stone-free rate and low morbidity in HSK patients.
• This technique represents a potential alternative for managing stones in horseshoe kidneys.
• Further studies are warranted to confirm these findings.