Percutaneous nephrolithotomy for large renal stones in anomalous kidneys

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is an important surgical method for managing renal stones of any size. Anomalous kidneys pose additional technical challenge to the operating surgeon to perform PCNL in these anatomically abnormal kidneys especially if the stone load is large. The aim of this study is to present the efficacy and limitations of PCNL in managing stones >2 cm in size in anomalous kidneys.Methods: This was a retrospective single centre study of PCNL in anomalous kidneys with stones >2 cm in size.Results: 30 patients of kidney stones >2 cm underwent PCNL. Our series of patients included 19 (63.32%) cases of horseshoe kidneys, 9 (30%) malrotated kidneys, 1 (3.34%) pelvic and 1 (3.34%) crossed fused ectopia. We achieved complete stone clearance in 26 (86.67%) patients. Presence of staghorn calculus was the most important statistically significant factor limiting complete clearance.Conclusion: PCNL is an effective procedure for management of patients with large stones in anomalous kidneys. Appropriate preoperative evaluation especially imaging, appropriate selection of cases and most importantly excellent technical expertise is needed to achieve high stone clearance rates with minimal morbidity.