Malrotated Kidney Research Articles

Сравнительный анализ результатов перкутанной нефролитотрипсии и лапароскопической пиелолитотомии

Percutaneous nephrolithotripsy (PNL) is considered as the main treatment method of patients with large and staghorn kidney stones. In some cases, laparoscopic pyelolithotomy (LP) may be an alternative option to PNL. The aim of our work was to compare the results of these surgical methods for treatment of large pelvis stones. The results of surgical treatment of 60 patients with large pelvis stones were reviewed. In 40 patients (66.7%) PNL were performed, while in 20 cases (33.3%) LP were done. In the PNL group, the average stone size was 2.7 (2.5-3.8) cm and in the LP group it was 3.0 (2.6-4.2) cm. Four patients in the LP group had kidney malrotation, one patient had pelvic dystopia, and in another case a horseshoe kidney was diagnosed. The operative time and stone-free rate, intra- and postoperative complications, the amount of blood loss and the length of hospitalization were compared. There was no conversion in both groups. There were no significant differences in the mean length of hospitalization (4.5+/-1.5 vs 4.4+/-1.4 days) and analgesic use (2.2+/-0.9 vs 2.4+/-1.0 days) and stone-free rate (100 vs 90%) between groups. The mean operative time was significantly higher at the PL (110.0+/-25.0 vs 65.4+/-24.5 min; p less or equal 0.05), but the amount of blood loss was significantly lower (70+/-28 versus 160.0+/-55 ml; p less or equal 0.05) compared to the PNL group. PNL remains the main treatment method for patients with large kidney stones. However, abnormal kidneys, concomitant ureteropelvic junction obstruction or endoscopic treatment failure can be indications to LP.

Changing trends in the endourological management of urolithiasis in anomalous kidneys.

To present our single-centre experience of urolithiasis management in anomalous kidneys, highlighting the need for an algorithm-based approach in deciding the appropriate treatment method for each type. We retrospectively reviewed the data of all the patients who presented to our renal unit with urolithiasis in an anomalous kidney between January 1990 and July 2014. The peri-operative characteristics of all the patients, along with management approach, were studied. Percutaneous nephrolithotomy (PCNL) was the most common surgical technique used, followed by flexibleureterorenoscopy (URS). Pain was the most common presentation in these patients. The overall stone clearance rate associated with PCNL and flexible URS was85.8% in cases of anomalous kidneys in this series. The stone clearance rates in ectopic kidneys, horseshoe kidneys, malrotated kidneys and autosomal dominant polycystic kidneys associated with PCNL and flexible URS were similar: 86%, 88%, 76% and 83%, respectively, and81.2%, 80%, 92% and 100%, respectively . Based onour results, we developed a stone management algorithm. The management of renal calculi in patients with renal anomalies may vary based on the stone size, location, density, pelvicalyceal system anatomy and drainage. An algorithm-based approach could help surgeons decide the appropriate treatment in this population.

First Case of Right Malrotated Kidney Transplantation

Vascular anatomy may widely vary in malrotated kidneys, depending on the degree of rotation. Polar arteries and venules are often accompanied by structural and positional anomalies of the kidney that can make donor nephrectomy more complicated. Detailed evaluation of the donor before surgery is very important for both surgeon and patient. In particular, vascular anatomy should be evaluated in detail by modern imaging methods in donor nephrectomy. Herein we share our experience with right malrotated kidney open donor nephrectomy.

Ureteroscopic Urinary Stone Treatment Among Patients With Renal Anomalies: Patient Characteristics and Treatment Outcomes

To evaluate patients' characteristics, surgical procedure data, and outcomes of ureterorenoscopy (URS) stone treatment in patients with a horseshoe kidney (HSK), ectopic kidney (EK), and malrotated kidney (MK). This study is a subanalysis of the Clinical Research Office of the Endourological Society URS Global Study, which was a prospective multicenter observational study, collecting data on URS stone treatment from consecutive patients over a 1-year period. A total of 114 centers in 32 countries participated. This analysis acuminated on URS stone treatment in the specified renal anomalies: HSK, EK, and MK. For each group, patient characteristics, operation data, and treatment outcomes were evaluated. Of the 11,885 patients included in the Clinical Research Office of the Endourological Society URS study, 43 patients had HSK, 27 EK, and 16 MK. The stone-free rate (SFR) in the HSK group was 77% for renal stones and 85% for ureteral stones. In the HSK group, the intraoperative complication rate was 11.6% and the postoperative complication rate was 7%, including 1 Clavien grade IIIa and 1 IIIb complication. In the EK group, the SFR was 20% for renal stones and 94% for ureteral stones, with an intraoperative complication rate of 14.8% and a postoperative complication rate of 7.4%. One Clavien IVa complication was reported. In the MK group, the SFR was 71% for renal stones and 88% for ureteral stones, with an intraoperative complication rate of 6.3%. No postoperative complications occurred in this group. URS is an effective and safe treatment modality to remove ureteral and renal stones in patients with HSK and MK. The effectiveness of URS for renal stones in EK was low.

Fluoroscopy free flexible ureteroscopy with holmium: Yttrium-aluminium-garnet laser lithotripsy for removal of renal calculi

ObjectiveTo evaluate the feasibility of access sheath insertion and ureteric stent placement without image guidance in flexible ureteroscopic lithotripsy with holmium:yttrium-aluminium-garnet laser for renal stones. Patients and methodsBetween March 2014 and October 2015, 80 patients with renal stones treated with flexible ureteroscopic laser lithotripsy were evaluated. Indications for surgery were renal obstruction, failed shockwave lithotripsy (SWL), stones in polycystic kidneys, and mal-rotated kidneys. A 6.5-F Cobra flexible ureteroscope was used in all cases with an access sheath of 12F, 35/45cm in length. Fluoroscopy was not intended for use in all cases and postoperative JJ stenting was optional. The perioperative complications were listed and the collected data were analysed. ResultsThe study included 80 patients (66 male, 14 female), with a mean (SD; range) age of 48.2 (8; 28–54) years and a stone burden of 13 (3.5; range 6–23) mm. In all, 26 patients had a stone burden of >15mm and 48 patients had lower calyceal stones. The mean (SD; range) operative time was 71.5 (20; 25–130) min. Overall, 76 (95%) access sheath insertions were performed successfully without the use of fluoroscopy. JJ stenting was used in 22 patients (27.5%). The mean (SD; range) hospital stay was 10 (8.5; 10–36) h. After one session, a stone-free rate (SFR) of 87.5% was achieved (93.3% for stones of <15mm). A single session was successful in 87.9% of cases with lower calyceal stones, with a SFR of 91.7% for post-SWL failure cases. The perioperative complication rate was 15%. ConclusionAccess sheath insertion without fluoroscopic guidance is feasible. This technique reduces radiation exposure in patients requiring flexible ureteroscopy.

Gastrointestinal system complications in percutaneous nephrolithotomy: a systematic review.

To evaluate gastrointestinal tract complications of percutaneous nephrolithotomy (PCNL), to determine risk factors, and to develop strategies for diagnosis and treatment. A literature review was conducted for the studies published in the English language in the databases of PubMed and Scopus between July 1985 and June 2013. The key words for digital literature search were limited to the following: "percutaneous nephrolithotomy complications, ([splenic injury, liver injury, gallbladder injury and biliary peritonitis, colonic injury] during/after [percutaneous nephrolithotomy]), complication, Clavien, Clavien-Dindo classification, management, review, PNL, PCNL." A total of 16 articles on splenic injury were reviewed. There was no consensus in the literature regarding the management of splenic injuries. A conservative approach with new treatment modalities is the most widely accepted method in the literature. A total of seven articles on gallbladder injury were reviewed. All gallbladder injuries resulted in cholecystectomy. The time of diagnosis is the most significant parameter determining choice between laparoscopy and laparotomy. A total of seven articles on liver injury were reviewed. The liver injury generally provides the best response to a conservative approach among other solid organ injuries. A total of 11 articles on bowel injury were reviewed. Bowel injury mostly results in exploratory laparotomy. Unlike colon injuries, bowel injuries are more complex to manage with conservative measures because of the challenges in diagnosis and the fact that the injury is located in the intraperitoneal area. A total of 28 articles, which comprised a large case series with colon injuries, consisted of collaborative reviews and meta-analyses were reviewed. In total, 51 colon injuries (0.5%) were evaluated occurring in 13,424 patients in supine and prone PCNL series. Conservative approaches have proven to be effective in colon injuries in the absence of large perforations and intraperitoneal involvement. There is a downward trend in gastrointestinal complications from PCNL because of the technologic advances that guide the diagnosis and treatment. Paradoxically, the rate of complications is higher in complex kidney stones such as those in a horseshoe kidney and pelvic and malrotated kidney that represent anatomic challenges for intervention. The most important point is to determine the risk factors for preoperative planning of the procedure and to diagnose the complications for proper management early.

Unstented laparoscopic pyeloplasty in young children (1–5 years old): A comparison with a repair using double-J stent or transanastomotic externalized stent

ObjectiveTo evaluate feasibility of unstented laparoscopic pyeloplasty in young children to prevent pyelonephritis and second anaesthesia. Patients and methodsDuring 2006–2013, 70 children (1–5 years old) underwent laparoscopic pyeloplasty for high grade hydronephrosis. Unstented repair was indicated in 34 children (GroupL1), double-J stent was placed in 21 patients (Group L2) and uretero-pyelostomy stent (Cook) in 15 patients (Group L3). Stenting was preferred in large thin-walled pelvis, thin ureter, kidney malrotation, and unfavourable course of crossing vessels. The outcome was compared with age-matched group of 52 children who had open surgery during 1996–2006 (Groups O1, O3). ResultsOperation times were significantly shorter in Groups L1 and L2 than in Group L3; the times were shorter in open repairs. Three patients with crossing vessels from Group L1 had urine leakage and one had obstruction (11.4%). In Group L2, one patient had obstruction, one incorrect placement of the stent, and one girl had serious pyelonephritis (14.3%). In Group L3, displacement of uretero-pyelostomy occurred in one patient (6.7%). There is no statistical difference between laparoscopic groups and between laparoscopic and open groups. ConclusionUnstented laparoscopic pyeloplasty is a safe procedure in selected young children with favourable anatomical conditions preventing additional anaesthesia and stent-related complications.

Laparoscopic Transmesenteric Nephrectomy for Nonfunctioning Hydronephrotic Crossed Renal Ectopia with Fusion

Introduction: Laparoscopy with low morbidity and a rapid recovery process than open surgery is a preferred surgical technique.1,2 Crossed renal ectopia is the most common fusion abnormality after the horseshoe kidney abnormality.3 In this video, laparoscopic transmesenteric nephrectomy for nonfunctioning hydronephrotic crossed renal ectopia from left to right with fusion is presented. The aim of this video is to illustrate how we can perform nephrectomy of nonfunctioning crossed renal ectopia with fusion anomalia, giving minimal damage to the normal kidney. Materials and Methods: A twenty-year-old mentally retarded male patient was admitted to the outpatient clinic with the complaint of abdominal pain. The left kidney was not visualisated, but a 15×10 cm cystic lesion in the right retroperitoneal area conjoined to the right kidney was observed in an ultrasonographic examination. In a computed tomographic examination, the absence of the left kidney was confirmed; however, there was a sharply marginated, homogeneous, cystic, without contrast enhancement 14×12×8 cm benign lesion in the lower half of the right kidney. Ventral malrotation of the right kidney and the compression of the lesion to the proximal ureter were observed. Early segmental arteries supplied by the right renal artery and millimetric arteries supplied by the right common iliac artery, extending toward the cystic mass was seen in computed tomography. Additionally, agenesis of the left seminal vesicle was seen. This cystic mass was thought to be left to the right ectopic kidney with these outcomes. Laparoscopic transperitoneal excision of the nonfunctioning, hydronephrotic cross-ectopic kidney was planned. Results: After creating pneumoperitoneum, the mass was seen transmesenterically. Without mobilizing the colon, we pass through the retroperitoneal space transmesenterically. The ectopic kidney was dissected from the surrounding tissues and excised. The operation time was 150 minutes and blood loss was 50 cc. The pathologic examination was reported as cystic kidney disease. After 6 months of follow-up, there was no pathology in the computed tomography. Conclusion: During the ascent of the kidney, it normally rotates anteromedially. Malrotation occurs if it fails to rotate or over-rotates. This anomaly can be unilateral or bilateral. Patients with renal malrotation have no specific complications, but malrotation is usually associated with other renal anomalies, such as ectopia with or without fusion or horseshoe kidney.4 The vesicoureteral reflux and malrotation of kidney may present with crossed renal ectopia. Coexistence of these abnormalities can lead to hydronephrosis and loss of renal function. Crossed renal ectopia should be considered in such patients who apply with nonspecific symptoms with concomitant anomalies. As a minimally invasive procedure, nonfunctioning, cross-ectopic nephrectomy can be performed laparoscopically with transmesenteric access without any damage at mesenteric tissues. None of the authors have any commercial associations that may create a conflict of interest in connection with this video. Runtime of video: 8 mins 26 secs

V1723 UPPER CALYXES PERCUTANEOUS ACCESS USING THE RENAL DISPLACEMENT WITH THE 18-GAUGE PUNCTURE NEEDLE

You have accessJournal of UrologyTransplantation and Urolithiasis1 Apr 2013V1723 UPPER CALYXES PERCUTANEOUS ACCESS USING THE RENAL DISPLACEMENT WITH THE 18-GAUGE PUNCTURE NEEDLE Mohammed Lezrek, Khalil Bazine, Mounir Drissi Touzani, and Amoqurane Beddouch Mohammed LezrekMohammed Lezrek Meknes, Morocco More articles by this author , Khalil BazineKhalil Bazine Meknes, Morocco More articles by this author , Mounir Drissi TouzaniMounir Drissi Touzani Meknes, Morocco More articles by this author , and Amoqurane BeddouchAmoqurane Beddouch Meknes, Morocco More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2924AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present a video of our experience of percutaneous renal upper pole access using a percutaneous renal displacement technique, to render the superior calyx reachable below the 11th rib. We describe a renal displacement technique using an 18-gauge needle, and its use in different situations. METHODS The needle renal displacement technique is performed under fluoroscopic guidance, with the X-ray beam perpendicular to the tract. Initially, a lower or middle calyx is punctured with an 18-gauge diamond-tipped needle. A stiff-shaft hydrophilic guidewire is inserted to protect urothelium from the needle-tip. The needle's proximal-end is progressively pushed in the cephalic direction. Consequently, the kidney is displaced caudally, by the lever manoeuvre. Secondly, the upper pole calyx is punctured, for tract formation. RESULTS Renal displacement has always been possible in kidneys with no surgical history. However, it failed when the kidney was fixed by post-surgical-adhesions. A caudal renal displacement, of many millimeters to few centimeters, is gained. There is also a slight inversion of the normal axis of the kidney. The renal upper pole becomes more accessible to puncture below the 11th-rib or even the 12th-rib, so decrease of intra-thoracic morbidity. This technique has also been used to immobilize mobile kidneys or to reorient complex malrotated kidneys. CONCLUSIONS percutaneous needle renal displacement technique may render the superior calyx more available while avoiding or decreasing intra-thoracic complications, but are effective only when the kidney is mobile. This technique can be used to perform some calyx reorientation and to fix very mobile kidneys. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e708 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammed Lezrek Meknes, Morocco More articles by this author Khalil Bazine Meknes, Morocco More articles by this author Mounir Drissi Touzani Meknes, Morocco More articles by this author Amoqurane Beddouch Meknes, Morocco More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparoscopic trans-peritoneal pyelolithotomy in a pelvic kidney.

Urinary lithiasis is one of the most common and the oldest known afflictions of the urinary tract. The management of renal stones has undergone radical changes in recent years, the latest being the minimally invasive procedures like extra-corporeal shock wave lithotripsy and percutaneous nephrolithotomy, making the open surgical procedures relatively obsolete. However, there are situations where the above-mentioned minimally invasive procedures prove to be lacking in achieving the cure; laparoscopic pyelolithotomy caters to such group of patients, e.g. the presence of calculi in malrotated or malpositioned kidneys. Herein, we report a case of pelvic kidney with a large calculus managed by laparoscopic trans-peritoneal pyelolithotomy.

Pyeloplasty for Pelvi-Ureteric Junction Obstruction in Malrotated Kidneys in Children

Pelvi-ureteric junction (PUJ) obstruction associated with malrotated kidney is very rare. In such cases, dismembered pyeloplasty poses technical difficulties. We present our experience with management of PUJ obstruction in malrotated kidneys in children and their outcomes. Retrospective review of case notes of all children who had pyeloplasty for PUJ obstruction associated with malrotated kidneys, over a period of 7 years between January 2003 and December 2009 at our institution. We identified four patients, and all four patients had malrotated kidneys with a lateral and slightly inferior facing renal pelvis. Anderson and Hynes dismembered pyeloplasty with inferior pelvi-ureteric anastamosis was performed in two patients (one patient with nephropexy and one patient without nephropexy), but failed to improve the drainage across the PUJ in both the patients. The remaining two patients underwent a dismembered pyeloplasty with anterior pelvi-ureteric anastamosis that resulted in a good drainage. One of the patients who had pyeloplasty with inferior pelvi-ureteric anastamosis had a redo pyeloplasty with anterior pelvi-ureteric anastamosis that restored the drainage adequately. In our experience dismembered pyeloplasty with inferior pelvi-ureteric anastamosis along with or without nephropexy has not been successful in cases of PUJ obstruction in laterally malrotated kidneys. Although the number of cases in our study is small, we have had a 100% success with dismembered pyeloplasty with anterior pelvi-ureteric anastamosis. The authors are of the opinion that this modified approach is recommended as a viable option both as a primary and salvage procedure for PUJ obstruction in laterally malrotated kidneys.

HOLMIUM-YAG LASER URETEROSCOPIC LITHOTRIPSY IN A PATIENT WITH ECTOPIC MALROTATED KIDNEY

The incidence of stone disease among patients with congenital renal anomalies including malrotated kidney is more than in normal population due to poor urine drainage and stasis (1). Various minimally invasive options have been used for the management. Ureteroscopy and Holmium:YAG laser lithotripsy have been reported with favorable outcomes (2). We report a 30-year-old male who presented to our hospital having a right side malrotated kidney with a large stone in it. He underwent two session of ureteroscopy and Holmium:YAG laser lithotripsy.

Oligomeganephronia in an adult without end stage renal failure

A 23year-old male was investigated for hypertension, moderate renal insufficiency, persistent proteinuria and bilateral small kidneys. The renal pathological features were diagnostic with greatly enlarged glomeruli (the mean diameter was 325μm, which was approximately two times larger than normal glomeruli), indicating oligomeganephronia (OMN). He also showed malrotated kidneys, expanded extrarenal pelvis, and hearing loss. Thus, these clinical and pathological features aided in diagnosing the renal disorder as OMN. This is a very rare case of OMN, which did not advance to end-stage renal failure as an adult. We believe that multiple anomalies might be suggestive findings of OMN in patients, such as renal insufficiency, persistent proteinuria, and bilateral small kidneys.

PROSPECTIVE COMPARATIVE STUDY OF MINIPERC AND STANDARD PNL FOR TREATMENT OF 1 TO 2 CM SIZE RENAL STONE

Sir, We read with great interest the above article by Mishra et al. [1] on the prospective comparative study of Miniperc and standard percutaneous nephrolithotomy (PNL) for the treatment of medium-sized kidney stones. In the article, the authors concluded the significant advantages of the Miniperc procedure for reduced bleeding leading to a tubeless procedure and reduced hospital stay. The stone-free rates and the complications were similar in both groups. However, we have some questions about this work. Firstly, why was shockwave lithotripsy (SWL) not chosen as a first-line therapy in these patients? At our institution, renal stones of <2 cm are managed by SWL, whereas stones of ≥2 cm are usually managed by PNL. The European Association of Urology and the AUA guidelines for the treatment of intrarenal calculi of <2 cm recommend SWL as the first-line therapy [2,3]. Because of its non-invasive nature, low complication rate, and high level of patient acceptance, SWL is usually the method of choice for the treatment of kidney stones. However, there is a broad consensus that the lowest success rate of SWL occurs with stones located in the lower calyces. The choice of therapy for lower pole stones of 10–20 mm is controversial and based on various stone, patient, and surgeon factors. Secondly, why was no retrograde intrarenal surgery (RIRS) technique used in these patients who had previously failed SWL? Because, despite its effectiveness major complications have been identified from PNL and occur at reported rates of 0.03–10% [4,5]. RIRS for medium-sized renal calculi is an acceptable alternative therapeutic method to PNL [6]. With the advent of the new generation of flexible ureteroscopes, with greater deflection and control, there has been an increase in endoscopic ureteroscopy and laser lithotripsy for renal calculi. Recent studies report stone-free rates of >90% for retrograde ureteroscopic management of renal stones and as high as 85% for the management of lower pole stones [7]. In our clinic, we decide upon the appropriate technique for treating stones of 10–20 mm according to pelvi-calyceal anatomy and patient choice. We prefer the PNL technique in patients who have a narrow lower-pole infundibulo-pelvic angle or infundibular width. And we prefer the RIRS technique in patients who have bleeding diathesis, musculoskeletal deformities, chronic obstructive pulmonary disease, morbid obesity or abnormal renal anatomy (horseshoe, pelvic, and malrotated kidneys, ectopic pelvic fusion anomaly).

Needle Renal Displacement Technique for the Percutaneous Approach to the Superior Calix

We describe a new renal displacement technique using an 18-gauge needle to facilitate superior calix puncture and consequently to decrease intrathoracic morbidity. Initially, a lower or middle calix is punctured with an 18-gauge needle. Then, the proximal end of the needle is progressively pushed in the cephalic direction. Therefore, the kidney is pushed caudally by the lever maneuver. This technique has also been used to immobilize the kidney or to reorient complex and malrotated kidneys.

Percutaneous Nephrolithotomy Among Patients with Renal Anomalies: Patient Characteristics and Outcomes; a Subgroup Analysis of the Clinical Research Office of the Endourological Society Global Percutaneous Nephrolithotomy Study

This study compared the characteristics and outcomes of percutaneous nephrolithotomy (PCNL) in patients with and without renal malformations using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. The CROES PCNL Global Study collected prospective data for consecutive patients who were treated with PCNL at centers around the world during 1 year. Patient characteristics, operative data, and outcomes of PCNL in patients with renal anomalies and those with normal kidneys were compared. Of 5542 patients whose renal anatomy was recorded, 202 (3.6%) patients had a renal malformation. The most frequent anomalies were horseshoe kidneys (1.8%) and malrotated kidneys (1.3%). The prone position was the most frequently used position for patients with renal anomalies as was upper pole puncture. PCNL achieved stone-free rates of 76.6% in patients with anomalous kidneys and 76.2% in those with normal kidneys. The frequency of complications was similar in the two groups. Median operative time was significantly longer (87 min vs 75 min, P=0.037), and access for PCNL was unsuccessful in significantly more patients (5% vs 1.7%, P=0.001) in whom renal anomalies were present. In patients undergoing PCNL, the presence of renal malformation is likely to extend operative time. Stone-free rates as well as incidence of complications after PCNL are similar irrespective of the presence of renal anomalies.

Bilateral malrotation and lobulation of kidney with altered hilar anatomy: a rare congenital variation

Variations of the structure and position of the kidney along with the variations of renal vessels are the most frequently reported. Rotational variations form a rare entity that is not cited in most of the embryology textbooks. During educational cadaveric dissection of a 57-year-old female, a complex picture of bilateral anatomical variants was encountered. Bilateral malrotation of kidney, bilateral lobulated kidneys along with open hilum of kidney was observed, so that the contents of the sinus were exposed. The renal pelvis was present anterior to the renal vessels instead of posterior position.The right kidney in addition showed lower lumbar position with three supplementary arteries and two veins. The right ovarian vein arched over the laterally rotated hilum of kidney and drained into superior renal vein instead of inferior vena cava. This is a rare case in which such numbers of congenital variations are seen. These variations of kidney have embryological base. Rotational variation though comparatively rare assumes great importance in view of the present day surgical procedures like percutaneous nephrectomy, renal transplantation, etc.

Percutaneous nephrolithotomy for the management of stones in anomalous kidneys in children

Purpose We report percutaneous nephrolithotomy for the management of stones in anomalous kidneys in children. Materials & methods We performed PCNL on 6 children (one with bilateral stones), 3 boys and 3 girls with anomalous kidneys. Three had horseshoe kidneys, 2 malrotated kidneys, and one crossed fused ectopic kidney. Their age ranged from 5 to 12 years with a mean of 7.3 ± 3 years. Two patients had previous failed ESWL, 4 underwent PCNL for large stone burden. Mean stone burden was 324.9 ± 191.8 mm 2. Under fluoroscopic guidance we performed serial dilatation using Alken metal dilators. In 4 patients 17 Fr rigid nephroscope was used, in 2 patients 26 Fr nephroscope was utilized. Pneumatic lithotripsy was used for stone disintegration and forceps for stone extraction. Results A single stage PCNL resulted in complete stone clearance in 5 children, while one required a second look procedure. Operative time ranged from 25 to 70 min with a mean of 43.3 ± 17.8 min. None of the patients required blood transfusion. Perforation of the renal pelvis occurred in one patient and was managed by prolonged insertion of nephrostomy tube. Hospital stay ranged from 1 to 6 days with a mean of 3 ± 2 days. Postoperative fever occurred in one child and persisted for 3 days. All children were followed for 3 months and were stone free. Patient with bilateral stones performed ESWL on the contra lateral side. Conclusion Children with stones in anomalous kidneys can be managed safely with PCNL when they are properly selected.

Effect of Simple Malrotation on Percutaneous Nephrolithotomy: A Matched Pair Multicenter Analysis

In this multicenter study we compared the outcome of percutaneous nephrolithotomy in patients with and without malrotated kidneys. A total of 44 patients (group 1) at 6 institutions who underwent percutaneous nephrolithotomy for kidneys with simple malrotation were enrolled in our study. Attending physicians in our group also provided the same number of cases of percutaneous nephrolithotomy done for nonmalrotated (normal) kidneys (group 2). Group 2 patients were selected by match pairing. Operative and postoperative data on the 2 groups were compared using the chi-square, Student t and Fisher exact tests. As a result of match pairing, the 2 groups were similar in age, gender, body mass index, and stone size and site. Mean ± SD stone size was 5.9 ± 3.5 cm(2) in group 1. Multiple access attempts were required in 9 (20.5%) and 7 cases (15.9%) in groups 1 and 2, respectively (p >0.05). Mean fluoroscopy time was 7.0 ± 3.9 minutes in the malrotated kidney group and 7.3 ± 4.5 minutes in the nonmalrotated kidney group (p >0.05). The mean hemoglobin decrease after percutaneous nephrolithotomy was significantly higher in group 1 (-1.9 vs -1.3 gm/dl, p = 0.008) but the blood transfusion rate was similar in the 2 groups. The procedure success rate in groups 1 and 2 was 77.3% and 79.5%, respectively (p >0.05). Percutaneous nephrolithotomy is safe and effective even in patients with larger kidney stones and malrotated kidneys.

Indications and outcomes of laparoscopic uretero-renal stone surgery

Although most ureteral and urinary stones are managed using endourologic techniques or shockwave lithotripsy in daily clinical practice, stone surgery has not completely disappeared. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. Indications for open or laparoscopic stone surgery are anatomic abnormalities, such as horseshoe kidneys, malrotated kidneys, ureteropelvic junction obstruction with stones, or ectopic kidneys; symptomatic stones in diverticula; extremely large stones and all those situations in which conventional endourologic procedures and extracorporeal shock-wave lithotripsy are not available or were unsuccessful or in those conditions where laparoscopy offers a priori the best solution to an endourologic complex condition. Laparoscopic surgery is effective for complex urinary stones and allows adjunctive procedures. It complements other minimally invasive procedures, and a need for open surgery has strongly diminished.