Abstract
Horseshoe kidney (HSK) is the common renal fusion congenital anomaly, affecting about 0.25% of the global population. Although most HSKs are detected incidentally, they may present with clinical findings, including urinary tract infections (UTI), stone formation, and obstruction. Nephrolithiasis, observed in 20% of patients with HSK, is a frequent indication for surgery. Due to the caudal and medial locations of calyces and the abnormal anterior position of the kidney, extracorporeal shock wave lithotripsy has shown a relatively low success rate in treating HSK. Percutaneous nephrolithotomy has also been associated with major complications in anomalous kidneys. Advances in laparoscopic instrumentation and techniques have made laparoscopic surgery a promising alternative for stone treatment in HSK. This report describes a 61-year-old woman who presented initially with recurrent UTI unresponsive to multiple courses of antibiotics. Urine cultures were positive for Escherichia coli. A computed tomography scan showed a right HSK with multiple renal stones (35 mm in the right lower pole with eight stones 2-4 mm in size), along with severe hydronephrosis. The patient was treated successfully with laparoscopic nephrolithotomy, indicating that laparoscopy is an effective and safe approach in the treatment of renal stones >2 cm in HSK.
Highlights
Horseshoe kidney (HSK) is the most common congenital type of renal fusion anomaly, with an incidence of 1:400 individuals, and is more prevalent in men than in women [1]
Most HSKs are detected incidentally, they may present with clinical findings, including urinary tract infections (UTI), stone formation, and obstruction
HSK may present with complications, such as urinary tract infections (UTI), stone formation, and obstruction [2,3]
Summary
Horseshoe kidney (HSK) is the most common congenital type of renal fusion anomaly, with an incidence of 1:400 individuals, and is more prevalent in men than in women [1]. Anatomical abnormalities in patients with HSK present a challenge in the treatment of kidney stones. Computed tomography (CT) scanning revealed a right-side HSK with multiple renal stones. An ultrasound scan of the abdomen showed a duplex right kidney with multiple stones associated with moderate-severe dilatation of the right pelvicalyceal system. She was referred to our department for further evaluation. A CT KUB showed a right HSK with multiple renal stones, measuring 35 mm in the right lower pole, and consisting of eight stones, 2-4 mm in size. The right kidney appeared severely hydronephrotic, with a large opacity extending from the renal pelvis to the lower pole and no flow of contrast through the right ureter (Figures 2, 3). The DJ ureteric stent was removed four weeks after the procedure
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