Nephron-Sparing Strategies for Tumor-Bearing Horseshoe Kidney: From Surgeries to Pharmaceuticals

Background/Objectives: Horseshoe kidney (HSK) is a type of congenital renal fusion anomaly with extreme anatomic complexity. The malrotation of kidneys and ureters and malformation and altered isthmus and vascular supply may boost several renal and extrarenal complications. Organ preservation of tumor-bearing HSK is rather difficult and only available in a small minority of patients. Methods/Results: This review introduces new advances for nephron-sparing surgical strategies for tumor-bearing HSK, such as super-selective artery clamping, ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy, and focal therapies. It also puts forward novel pharmaceuticals for kidney function preservation to alleviate ischemia-reperfusion injury and medications for neoadjuvant therapies. Conclusions: HSK possesses unique etiology, complex anatomic characteristics, and hidden complications. Renal function preservation is extremely important for tumor-bearing HSK. For long-term high-quality lifespan, precise preoperative planning, surgeon's versatility with multiple surgical techniques, and novel pharmaceuticals to avoid IRI are promising strategies for nephron-sparing surgery.