In summing up the clinical management of horseshoe kidney it is obvious that accuracy in establishing a correct diagnosis and the proper indications for medical, urological and surgical treatment are the paramount considerations for the assurance of a sound prognosis. Horseshoe kidney disease as a new clinical entity can be easily recognized both clinically and radio-urographically, and whenever the horseshoe syndrome of nephralgia and other clinical manifestations is suggestively present, the urographic examination will confirm and verify the final diagnosis. Bilateral instrumental pyelograms whenever possible (taken at different sittings if necessary) or intravenous uroselectan pyelograms are absolutely necessary, not only for the verification of the diagnosis but also in order to exclude the possibilities of other abnormalities, since the lack of, or the incomplete, rotation and inward inversion of one pelvis seen in a unilateral pyelogram, does not always mean the presence of horseshoe kidney. We must also exclude the embryonic type of renal pelvis and the unusually placed pelvis due to an ectopic kidney or dystopic asymmetric renal fusion, or to a certain degree of nephroptosis, or to torsion or renal misplacements resulting from trauma or intraperitoneal or extraperitoneal neoplasma. To this end the routine procedure of measuring the basal angle in the horseshoe triangle as here proposed by the author will serve as a means of eliminating error and clarifying the final diagnosis. Nevertheless, it is essential that the diagnosis shall correspond with the clinical condition of the patient, and to be complete it should be based in the following roentgenographic and urographic data: (1) The visualization of the outline and position of the kidneys; (2) the possible delineation of the isthmus; (3) renal shadows of calculi close to the vertebral column or overlapping it; (4) in a bilateral pyelogram, the abnormal rotation of the pelves; (5) the lower calices pointing inward; (6) the “flower vase” position of the ureters; (7) the “bottle neck” shape at the ureteropelvic junction; and (8) the “pathognomonic pyelographic horseshoe triangle” with its minimum basal angle hovering around 20 °. A consideration of all these points in the diagnosis will definitely reveal the presence of the clinical entity of horseshoe kidney disease. In looking over this series of cases, one cannot fail to be struck by the fact, that, of the group of 19 patients diagnosed preoperatively, practically every one came in with an erroneous diagnosis, and 12 of this group had already been operated upon elsewhere for various abdominal conditions, before our diagnosis of horseshoe kidney was made, thus bringing out the paramount importance and necessity of a correct preoperative diagnosis. The treatment of this condition in acute cases should be medical and urological, but later on, when the patient has recuperated from the acute symptoms and complete invalidism, and before any further pathology develops, it should always be surgical, establishing the division and separation of the isthmus of the fused organ by renal symphysiotomy. This operative procedure should be followed at the same time by a nephropexy or suspension of one half of the organ on the side where the operation has been performed. Care should also be taken to free the ureter and pelvis from bands of adhesions and aberrant blood vessels, in order to restore ureteric and pelvic dynamic physiological function and to secure a better drainage.