Percutaneous nephrolithotomy in treatment of large stones within horseshoe kidneys

Abstract

Objectives To present our experience with percutaneous nephrolithotomy (PCNL) in the treatment of large stones within horseshoe kidneys. Methods The study included 34 patients with 45 stone-bearing horseshoe kidneys treated by PCNL in one center. The indications for PCNL were large stone burden (greater than 2 cm) in 10 kidneys (22.2%), multiple complex stones in 22 (48.9%), staghorn stones in 3 (6.7%), and failed extracorporeal shock wave lithotripsy (ESWL) in 10 kidneys (22.2%). All PCNL procedures were performed in a standard one-session technique with fluoroscopic guidance. Procedures were evaluated for intraoperative and postoperative complications, use of auxiliary procedures (second-look PCNL, ureteroscopy, and ESWL), and length of hospital stay. Moreover, the stone-free rate was calculated at discharge from the hospital and 3 months later. In addition, we assessed the need for secondary intervention during a mean follow-up of 75 ± 16 months (range 6 to 108). Results The stone burden ranged from 264 to 2408 mm 2 (mean 664 ± 153). Access to the horseshoe kidneys was supracostal in 10 (22.2%) and subcostal in 35 kidneys (77.8%). A single tract was used in 37 (82%), and two tracts were created in the remaining 8 kidneys (18%). Major complications were seen in six PCNL procedures (13.3%) and included significant hematuria requiring blood transfusion in three, septicemia in one, ureteral obstruction in one, and colonic injury in one. All complications were successfully treated. Auxiliary procedures were required in 12 patients (35.3%) and included ureteroscopy in 1, second-look PCNL in 3, and ESWL to fragment residual caliceal stones in 8 patients. The mean hospital stay was 4 ± 1.9 days (range 3 to 12). The stone-free rate was 82% at discharge and 89% at 3 months. During the course of follow-up, 19 patients (56%) developed stone recurrence and were successfully treated with ESWL in 8 and PCNL in 11. Conclusions PCNL is a safe and effective procedure in the treatment of large stones within horseshoe kidneys.