Abstract
ABSTRACTPurpose:To evaluate the clinical efficacy of flexible ureteroscope (F-URS) combined with holmium laser lithotripter in treating renal calculi in horseshoe kidney.Materials and Methods:From November 2010 to December 2013, the medical history and charts of sixteen patients (mean age 42.9±11.6 years, range 26-66 years), including 13 males and 3 females were analyzed retrospectively. Mean stone burden was 29±8 mm (range 17-42 mm2). Mean stone digitized surface area (DSA) was 321±94 mm2 (range 180-538 mm2). Under spinal anesthesia in a modified lithotomy position with the head down, rigid ureteroscope was placed firstly into the ureter to reach the level of the pelvis, a zebra guide wire was inserted and following the removal of the rigid ureteroscope, an ureteral access sheath was positioned along the guide wire, then passed the URF P-5 flexible ureteroscope into the renal cavities over the guidewire. After locating the stones, holmium laser lithotripsy was performed.Results:The average operative time was 92±16 minutes (range 74-127 min.). No major complications were encountered. Ten patients obtained stone-free status with one session, four obtained stone-free status after two sessions. Single session stone-free rate was 62.5%, overall stone-free rate was 87.5%. Two patients have small residual stones in the lower pole.Conclusions:F-URS combined with holmium laser lithotripter and nitinol basket, is safe and effective in dealing with moderate stone diameter (<30 mm) in HSKs with high clearance rates and low complication rates.
Highlights
The horseshoe kidney (HSK) is the most common renal fusion anomaly, with a prevalence of 0.25% of the population
Impaired drainage of the collecting system and associating ureteropelvic obstruction predispose the patient to urinary tract infection (UTI) and urolithiasis
Plain films taken on postoperative day one and four weeks later showed that ten patients received only one session of flexible ureteroscope (F-URS) and acquired stone-free status, and single-session stone-free rate was 62.5%; six patients received two sessions and four of them acquired stone-free status, while the other two had small residual stone in the lower pole, 7x6 mm in one patient and 8x6 mm in the other
Summary
The horseshoe kidney (HSK) is the most common renal fusion anomaly, with a prevalence of 0.25% of the population. The normal ascent of the kidneys is arrested by the fusion of the lower poles, resulting in malrotation with anterior displacement of the collecting system. Insertion of the ureter onto the renal pelvis is superiorly and laterally displaced. Impaired drainage of the collecting system and associating ureteropelvic obstruction predispose the patient to urinary tract infection (UTI) and urolithiasis. The latter of which is the most common complication of horseshoe kidney with an incidence of 21% to 60% [1]. A high incidence of metabolic abnormalities was identified in the stone-bearing patients with HSKs, suggesting that metabolic abnormalities, rather than anatomical ibju | Flexible Ureteroscopic Management of Horseshoe Calculi anomaly or urinary stasis, contribute largely to the propensity of urolithiasis in HSKs [2,3,4,5]
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