Stones In Horseshoe Kidney Research Articles

Retrograde endoscopic treatment of stones in horseshoe kidney

Retrograde endoscopic treatment of stones in horseshoe kidney

Results of laparoscopic management of stones in horseshoe kidney at a tertiary referral hospital

The management of kidney stones in patients with horseshoe kidney is a challenge for all urologists, given the low prevalence of the anomaly. There are very few reports of treatment through laparoscopic pyelolithotomy in the literature. Our aim was to share the results and experience obtained in the treatment of stones in horseshoe kidney through transperitoneal laparoscopic pyelolithotomy. Methodology: A retrospective, observational, cross-sectional, analytic study was conducted on patients diagnosed with horseshoe kidney and kidney stones, confirmed by non-contrast abdominal tomography, and treated through transperitoneal laparoscopic pyelolithotomy, within the time frame of January 2010 and January 2020. Results: There were 4 cases of renal pelvic stones in horseshoe kidney, all of which were men. Mean patient age was 33.5 years, mean BMI 32.25 kg/m2, mean surgery duration 125 minutes, mean blood loss 55 ml, and mean hospital stay 2.75 days. The stone-free rate was 100 %. Blood loss and age, blood loss and stone size, and BMI and surgery duration were significantly correlated. Conclusions: Based on our experience, transperitoneal laparoscopic pyelolithotomy is an excellent alternative for treating kidney stones in patients with horseshoe kidney.

Comparison between different techniques for management of renal stones in horseshoe kidneys

Abstract Objective To report the operative management , intra and post operative complications and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidneys. Materials and Methods We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 20-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. Results In all, 80 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 28 patients. 12 patients had laparoscopic assisted PCNL , 8 had flexible ureteroscopy and 18 had laparoscopic pyelolithotomy . PCNL was used for large stones = (mean digitized surface area= 614.32 mm 2 ) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures. only 33% of patients treated with flexible ureteroscopy was cleared from stones in one session and surprisingly, 89% of patients treated with laparoscopic pyelolithotomy was stone free after one session Complications were minimal, with 15% minor and 3% major complications in the PCNL group only.. Conclusions Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.

Percutaneous Nephrolithotomy in Horseshoe Kidneys: A Cross-sectional Study

Introduction: Horseshoe Kidneys (HSK) are the most common congenital fusion of the kidneys. After the reports of Wickham and Kellet in 1981 and Clayman in 1983, percutaneous extraction of stones in HSKs has been widely adopted. In this era of advancement of Retrograde Intra Renal Surgery (RIRS), Percutaneous Nephrolithotomy (PCNL) still holds strong position for HSK stone management, due to HSK vascular and pelvicalyceal anatomy. Aim: To evaluate PCNL in managing large HSK stone disease in the form of stone free rate and to assess procedure related complication between October 2016 to March 2020. Materials and Methods: A retrosepective cross-sectional study was conducted between October 2016 to March 2020, in total of 18 patients (21 renal units) underwent PCNL for stone disease in HSK. Stone size >1.5 cm, failed Extra-Corporeal Shockwave Lithotripsy (ESWL) and recurrent stones were included in the study. Results: Mean age of the patients was 40.67±7.87 years, 12 were male and 6 were female. Three patients had stones in both renal units. The mean stone size was 22.19±7.43 (12.00-46.00) mm. Twelve units had stone in the pelvis (57.1%), 6 unit in upper calyx (28.6%). One unit (4.8%) had stone in isthmus and 3 units (14.3%) had staghorn calculi. Access site was upper calyx in majority 76.2% of the cases, 23.8% required additional puncture most commonly through middle calyx. Total 8 patients had postoperative complications, fever being the most common (19%). Complete clearance was obtained in 85.7%, while 14.3% had residual calculi for which ancillary procedures were performed. Conclusion: PCNL can be recommended as the first line of management in the treatment of HSKs with large stone burden, considering its higher clearance rate and minimal complications.

Litíase em Rim em Ferradura em Doente com Ureter Reimplantado: A Propósito de um Caso Clínico

O rim em ferradura é uma anomalia renal congénita muito comum, estando muitas vezes associada a infeções do trato urinário e a litíase renal como consequência das alterações anatómicas que dificultam uma drenagem eficaz de urina. O tratamento dos cálculos nestes casos torna-se um desafio devido às anomalias anatómicas subjacentes exigindo uma adaptação das técnicas normalmente utilizadas para o tratamento da litíase renal.
 O artigo reporta o caso de uma mulher de 44 anos, com uma história de reimplantação ureteral à esquerda do tipo Cohen por refluxo vesico-ureteral na infância e com litíase renal. A doente apresentava dois cálculos com 12 e 10 mm de maior diâmetro no pielão superior do hemi-rim esquerdo, cujo infundíbulo tinha um calibre estreito. Procedeu-se a uma ureterorrenoscopia flexível com litotrícia laser Holmium através da colocação de uma baínha ureteral acima do infundíbulo estreitado tendo a doente ficado sem cálculos no final do procedimento.
 Torna-se importante, nos casos de litíase em rim em ferradura, pensar e adaptar as várias técnicas disponíveis para o tratamento da litíase renal e eleger aquela que, à partida, proporcionará uma maior taxa de sucesso com menos complicações.

A modified minimally invasive percutaneous nephrolithotomy for the treatment of horseshoe kidney stones: report of 12 cases

目的 探讨改良微创经皮肾镜取石术(minimally invasive precutaneous nephrolithotomy，MPCNL)治疗马蹄肾结石的临床疗效。 方法 选择本院2014年1月至2016年9月的马蹄肾结石患者12例，共13侧，采用改良MPCNL治疗，回顾性分析其临床资料。 结果 12例肾结石一期手术均取得成功。术中持续肾盂压力平均为13.5(11.6～14.2)mmHg，平均手术时间为95.2(62～145)min，一期结石清除率92.3%，平均住院天数6.3(6～7)d，术后均无发热、无周围脏器损伤、无大出血、休克及死亡等重大并发症。 结论 改良MPCNL治疗马蹄肾结石是一种安全有效的方法。

Outcome of Percutaneous Nephrolithotomy in Horseshoe Kidneys

Introduction: The horseshoe kidney is extremely rare, the incidence being one in every 400 - 800 patients. In a recent review of more than 15000 radiographic imaging studies, the incidence was one in every 666 patients. The renal stone formation in horseshoe kidney is around 20-80%. Percutaneous nephrolithotomy is the most accepted modality of treatment . This study was carried out to find the outcome of percutaneous nephrolithotomy in horseshoe kidneys.
 Methods: Between May 2013 and November 2017, 11 adult patients(12 renal units) with stones in horseshoe kidneys underwent percutaneous nephrolithotomy in the department of urosurgery, Kathmandu Medical College and Teaching Hospital and were evaluated for the operating time, stone free rate , complications and hospital stay. Data analysis was done using Statistical Package for the Social sciences (SPSS) Version 20. Categorical data were analysed by using Fisher exact test.
 Results: The mean age of the patients was 30.9 years (SD = 10.3) and the mean stone burden was 385.83 mm2 (SD = 331.3). The overall stone free rate was 83.33%. The two patients with residual stones when counselled for Extracorporeal shock wave lithotripsy, refused for it and decided to be on follow up. No auxiliary procedure was done. The complications noted were of Clavien-Dindo grade I and II. No pleural or bowel injury was seen. One patient needed blood transfusion.
 Conclusions: Percutaneous nephrolithotomy is safe and effective in the management of stones in horseshoe kidneys. It does not carry increased risk than reported in normal kidneys.

Different managements of horseshoe kidney stones, any difference in the outcome?

Purpose:The aim is to assess the outcomes of different approaches for the management of renal stones associated with horseshoe kidneys (HSKs) in our institution over a 12-year period.Methods:A retrospective review of 144 patients with HSKs who presented from 2000 to 2012 was performed. Twenty-eight patients (19.4%) were found to have renal stones. Demographic data were collected; the method of treatment and the outcomes of stone management were reviewed. We excluded patients with non-functioning moieties and associated genitourinary anomalies, and those with incomplete data.Results:We included 25 patients, of which 16 males (64%) and 9 females (36%), with a mean age of 37 years. Mean serum creatinine level was 66 mmol/L. Eleven patients with a stone size <8 mm were treated expectantly with medical treatment, with only one patient requiring endoscopic intervention. Six patients (24%) with a stone size between 1 cm and ≤2 cm were treated with extracorporeal shock wave lithotripsy (ESWL) with the placement of double J stents, and seven patients (28%) with a stone size of >2 cm were treated with percutaneous nephrolithotomy. One patient with a 10 mm stone was treated using flexible ureteroscopy. No significant perioperative complications were encountered.Conclusions:Indications, methods of treatment, and outcomes of management of stones associated with HSKs were comparable to those for stones associated with normal kidneys. Tailored approach based on stone size is highly recommended. ESWL accompanied with ureteric stenting is a promising strategy for the management of stones associated with HSKs in selected patients requiring intervention.

419 - Transperitoneal laparoscopic pyelolithotomy versus retrograde intrarenal surgery for treatment of renal pelvis stones in horseshoe kidneys: A prospective randomized study

419 - Transperitoneal laparoscopic pyelolithotomy versus retrograde intrarenal surgery for treatment of renal pelvis stones in horseshoe kidneys: A prospective randomized study

Flexible ureteroscopy for lower calyceal stones in a horseshoe kidney – Is it the new treatment of choice?

IntroductionThe efficacy of retrograde intrarenal surgery (RIRS) for the treatment of disorders in a horseshoe kidney has not been sufficiently studied so far. We report on our experience with this method for the treatment of lower-pole calculi in patients with a horse-shoe kidney. Patients and methodsThe files of 9 patients who underwent RIRS for lower calyceal stones in horseshoe kidneys between April 2012 and December 2014 were retrospectively analyzed. The stone-free status, postoperative complications, operative time and duration of hospitalization were assessed. ResultsIn total, 12 renal units with lower calyceal stones were treated, as 3 patients had stones in both kidneys. In 8 renal units complete stone clearance could be achieved in one sitting (67.7%), while in 3 renal units 2 sittings were necessary in order to achieve stone clearance. One patient with a stone sized 18mm still had residual stones after two sittings and, therefore, underwent percutaneous nephrolithotomy (PCNL) for stone clearance. No major complications (Clavien–Dindo grades III–V) were encountered. ConclusionRIRS for the treatment of stone disease in horseshoe kidneys has been shown to be a relatively safe and effective procedure. However, due to the anatomical abnormality, a second look may be needed to render the patient completely stone-free.

S&T-42 DIFFERENT MANAGEMENT OPTIONS FOR HORSESHOE KIDNEY STONES: SINGLE CENTER EXPERIENCE.

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-42 DIFFERENT MANAGEMENT OPTIONS FOR HORSESHOE KIDNEY STONES: SINGLE CENTER EXPERIENCE. Abdulhakim Al Otay, Osama Sarhan, Ahmed Al Helaly, Khalid Albedaiwi, Mustafa Al Ghanbar, Ziad Nakshabandi, and Ali Obeid Abdulhakim Al OtayAbdulhakim Al Otay More articles by this author , Osama SarhanOsama Sarhan More articles by this author , Ahmed Al HelalyAhmed Al Helaly More articles by this author , Khalid AlbedaiwiKhalid Albedaiwi More articles by this author , Mustafa Al GhanbarMustafa Al Ghanbar More articles by this author , Ziad NakshabandiZiad Nakshabandi More articles by this author , and Ali ObeidAli Obeid More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2871AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Horseshoe kidneys have a prevalence rate of 0.25% among population. Occurrence of renal stones associated with this anomaly has been reported up to 20%. Due to the high insertion of the ureter into the renal pelvis, there is a relative impairment of renal drainage which increases the risk of stone formation. We did this review to assess the outcome of different management approaches to treat stones associated with this anomaly. METHODS A retrospective review of 144 patients with horseshoe kidneys over ten year period (2000-2010) was performed. Twenty five patients (17.5%) were found to have renal stones. Demographic data of these patients were collected in addition to laterality, method of treatment, serum creatinine levels and the outcome of stone management was reviewed. We excluded patients with non-functioning moieties, those with associated genitourinary anomalies, and those with renal impairment or incomplete data. RESULTS We included 21 patients, 13 males (62%) and 8 females (38%) with a mean age of 41 years (2-78). Mean serum creatinine was 60 mmol/L. Eleven patients (52%) had stones in the left compartment, while 6 patients (29%) had it on the right one and 4 patients (19%) had bilateral renal stones. Patients with stone size less than 8 mm (9 patients) were treated expectantly with hydration and alkalization and only one patient required endoscopic intervention. Six patients (28.5%) with stone size between 1cm and less than 2cm were treated successfully with shock wave lithotripsy (SWL) with placement of double J stents and 6 patients (28.5%) with stone size of more than 2 cm were treated successfully with percutaneous nephrolithotomy (PNL). No significant peri-operative complications were encountered after all procedures. CONCLUSIONS Indications, method of treatment and outcome of management of stones associated with horseshoe kidneys are comparable to those with normal kidney morphology. A tailored approach based on stone size is highly recommended. In our study if intervention was required, SWL showed good stone free rate if accompanied with ureteric stenting and PNL appeared to be highly effective in achieving high stone-free rate with minimal morbidities. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e325 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Abdulhakim Al Otay More articles by this author Osama Sarhan More articles by this author Ahmed Al Helaly More articles by this author Khalid Albedaiwi More articles by this author Mustafa Al Ghanbar More articles by this author Ziad Nakshabandi More articles by this author Ali Obeid More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical effect of extracorporeal shock wave lithotripsy in the treatment of horseshoe kidney stones

Objective To explore the clinical effect of extracorporeal shock wave lithotripsy (ESWL) for the treatment of horseshoe kidney stones. Methods A total of 42 cases of horseshoe kidney stones from March 1987 to January 2015 were enrolled. Among them , 33 cases were male and 9 cases were female. Their age range was 19 to 71 years , average age was 42 years old. 25 cases got left renal pelvis stone, 17 cases were on the right renal pelvis side. The diameter range of stone was 0.4-3.7 cm, the average was 1.8cm. ESWL was applied to treat whole group. The prone position was used to removing calculus. The frequency of treatment was 2000-2700 times, with an average of 2500 times; the treatment voltage was 4-7KV. The gravel time of the treatment was 30-45min, the average was 35min. Results One time for ESWL was 29 cases, two times for ESWL was 8 cases, three times for ESWL was 3 cases, four times for ESWL was 2 cases. The first discharge stones time was 3 to 10 days. There was no special discomfort after operation. 40 cases got hematuria after operation, which occurred in 1 to 3 days after ESWL. Renal colic was in 7 cases which happened on 1-3 days after ESWL. Conclusions Calculi in horseshoe kidney may be treated by ESWL. It is a safe and simple operation. The prone position may bring satisfactory effect. Key words: Horseshoe kidney stone; Extracorporeal shock wave lithotripsy; Prone position

Do Outcomes of Percutaneous Nephrolithotomy in Horseshoe Kidney in Children Differ from Adults? A Single-Center Experience.

To compare the efficacy, outcome, and safety of percutaneous nephrolithotomy (PCNL) for stones in horseshoe kidney (HSK) in children compared with adults. We retrospectively reviewed data of 18 renal units in children (<15 years) and 26 renal units in adult patients with HSKs who underwent PCNL between March 2008 and June 2015. Mean age of the study group was 25.92 ± 15.79 with adults having 36.12 ± 11.84 (range 20-65) and children having 10.32 ± 2.88 (range 5-15). Mean stone burden was 311.20 ± 203.99 (104-1080 mm(2)) with children of 211.13 ± 130.21 (104-500 mm(2)) and adults of 382.68 ± 219.27 (114-1080 mm(2)). Success rate is defined as either complete stone free or with asymptomatic and clinical insignificant residuals fragment of <3 mm on postoperative imaging. Initial success rate was 79.54% (86.61% in adults vs 72.22% in children). After auxiliary procedure, the final success rate is 93.18% (adults: 92.30% vs children: 94.44%). Overall complications noted in 12 cases with 23.07% in adults and 33.33% in children, most of them were minor complications. There was no significant difference in initial and final success rate. Complication is slightly higher in children although statistically not significant. The outcomes and complications are similar to those reported in other studies of pediatric PCNL. Outcomes in child and adult HSKs do not differ significantly with respect to success rate and complications. Children have a relatively smaller stone burden compared with adults with a similar distribution. We found that most of the puncture can be made infracostal in children as well as adults.

Percutaneous Nephrolithotomy in Horseshoe Kidney: Our First Experience

OZET amac The safety and success of percutaneous nephrolithotomy (PCNL) was investigated in patients with kidney stones in horseshoe kidney. PCNL in horseshoe kidney is as safe and successful as in normal kidney.

Factors affecting outcomes of percutaneous nephrolithotomy in horseshoe kidneys.

To analyze the patient- and procedure-related factors affecting the outcomes of percutaneous nephrolithotomy (PNL) in horseshoe kidneys (HSKs). A retrospective analysis was done of patients with stones in HSKs treated with PNL in 3 referral centers between 1998 and 2013. Demographics, along with perioperative characteristics, were evaluated in detail as to whether or not they had an effect on the success and complication rates. A total of 54 HSKs with calculi in 53 patients were treated with PNL. Mean stone size was 28.4 ± 19.6 mm (range, 10-120 mm). Fifty-three patients were treated through a single tract, and 1 patient required additional access. Access was directed to the upper calyx (n = 27), middle calyx (n = 17), and lower calyx (n = 10) through the intercostal (n = 23) and subcostal (n = 31) areas. Flexible nephroscopy was used in 18.5% of the procedures. Postoperative complications were observed in 9 (16.7%) of the procedures. Success rate was 66.7% after a single session of PNL and increased to 90.7% with additional treatments. Although patient demographics, preoperative imaging, and other operative measures did not have significant effect on the complication rate, stone complexity and multiplicity, in combination with flexible nephroscopy, were found to significantly affect the success rate (P = .026, P = .043, and P = .021, respectively). However, in multivariate analysis stone multiplicity was the only factor that affected success rate (P = .004). Stone parameters play an important role in achieving stone-free status in HSKs. Use of flexible nephroscopy positively affects the success rate by allowing reaching the peripherally located calices.

Retrograde intrarenal surgery in patients with horseshoe kidneys

Retrograde intrarenal surgery (RIRS) in patients with horseshoe kidneys (HSKs) remains poorly studied. The present study aimed to assess clinical success and stone-free rates in HSK patients with renal stones treated with flexible ureteroscopy. RIRS was attempted in 20 patients with 25 renal stones in HSK from December 2008 to January 2012. The patients were evaluated with imaging studies including plain abdominal radiography, intravenous urogram, abdominal ultrasonography or non-contrast tomography scan. Success rate was defined as stone-free or residual fragment less than 4mm. Pre-operative, operative and postoperative data were retrospectively analyzed. A total of 20 patients were included in the present study (12 males, 8 females). 9 of 25 renal stones (36%) were located in the lower calyx of the kidney, whereas 7 (28%) in the middle calyx, 5 (20%) in the renal pelvis and 4 (16%) in the upper calyx. The mean stone size was 17.8±4.5mm. The stone-free rate was 70% after a single procedure. 6 patients required shock wave lithotripsy and two of these were completely stone-free. Average hospital stay was 1.4±0.7days. Minor complications as classified by Clavien I or II occurred in 25%. No major complications (Clavien III-V) occurred in the study group. RIRS is an effective and safe treatment modality for renal stones in patients with HSK. The procedure has minimal morbidity and high success rate.

Ureteroscopy-assisted retrograde nephrostomy for lower calyx calculi in horseshoe kidney: two case reports

IntroductionWe previously reported on the effectiveness of ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy and report two cases of lower calyx calculi in horseshoe kidney that were successfully treated with ureteroscopy-assisted retrograde nephrostomy. During the ureteroscopy-assisted retrograde nephrostomy procedure, a ureteroscope is advanced in the desired calyx and a Lawson retrograde nephrostomy puncture wire is inserted. The wire is advanced through the calyx to exit the skin. The wire is then used for the percutaneous dilation.Case presentationCase 1 was a 68-year-old man who was shown on radiography to have left lower calyx calculi (19 × 15mm, 7 × 5mm, and 7 × 3mm) in horseshoe kidney. Case 2 was a 36-year-old woman shown on radiography to have a left lower calyx calculus (10 × 8mm) in horseshoe kidney.ConclusionsBoth patients were stone-free after ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy. Ureteroscopy-assisted retrograde nephrostomy is a promising procedure for safely and effectively treating lower calyx stones in horseshoe kidney.

Calculs urinaires et rein en fer à cheval : place de l’urétérorénoscopie souple-laser

We aim to assess the outcome of the flexible ureterorenoscopy (F-URS) with holmium laser in treating horseshoe kidney (HSK) stones. We reviewed retrospectively the records of 18 patients with HSK stone (18 renal units) who underwent F-URS using holmium laser from December 2004 to October 2009. The mean age was 37.7±6.9 years. The F-URS used after the extracorporeal shock wave lithotripsy (ESWL) failure in eight patients (44.4%) and four patients (22.2%) had PCNL failure. The follow up visit range were between 4 and 6 weeks with plain radiograph (KUB) and renal ultrasound or non contrast computed tomography scan (NCCT). Success rate was defined as stone free or residual fragment less than 3 mm. Use of auxiliary procedures like ESWL were considered as treatment failure. Eighteen patients, three females and 15 males with mean age was 37.7±6.9 years with HSK calculi underwent ureteroscopic management. The presenting symptoms were renal colic, urinary tract infection or hematuria. We found different HSK stone location (11 mixed calyceal, three mixed pelvic and calyceal and four pelvic). The average stone burden was 15.5±7.3 mm and the mean operative time was 112±9.4 minutes. All over procedures were 27, with mean average of 1.5 procedures per patient. The success rate was 89%. The F-URS with holmium laser is an efficient minimal invasive procedure in treating HSK stones.

Flexible Ureterorenoscopy With Holmium Laser in Horseshoe Kidneys

To assess the outcome of flexible ureterorenoscopy (F-URS) with the holmium laser in treating stones in the horseshoe kidney (HSK). We retrospectively reviewed the records of 17 patients with a HSK stone (17 renal units) who had undergone F-URS with the holmium laser from December 2004 to May 2009. The presenting symptoms were renal colic, urinary tract infection, or hematuria. F-URS was used in as an alternative after the failure of shock wave lithotripsy in 8 patients (47%) and percutaneous nephrolithotomy failure in 4 patients (23.5%). Follow-up examination was performed after 4-6 weeks with plain radiography and either renal ultrasonography or noncontrast computed tomography. Success was defined as stone-free status or residual fragments <3 mm. The use of auxiliary procedures was considered to indicate treatment failure. A total of 17 patients were included in the present study (3 females and 14 males). Their age was 16-52 years (mean age ± SD 34.7 ± 6.3). The HSK stone location was 7 mixed caliceal, 3 mixed pelvic and caliceal, and 7 pelvic. The average stone burden was 16 mm (range 7-35). The overall number of procedures was 25 (mean 1.5 procedures/patient). Of the 17 patients, 15 (88.2%) were rendered stone free. The results of our study have shown that F-URS with the holmium laser is an efficient minimal invasive procedure for treating HSK stones.

Percutaneous nephrolithotomy in horseshoe Kidneys: is rigid nephroscopy sufficient tool for complete clearance? a case series study

Backgroundthis study represents a case series to evaluate how successful is the rigid percutaneous nephroscopy as a tool for clearance of all stones in various locations in horseshoe kidneys.MethodsBetween 2005 and 2009, we carried out PCNL (percutaneous nephrolithotomy) for calculi in horseshoe kidneys in 21 renal units (17 patients) in our department. The indications were large stone burden in 18 units and failed SWL(shock wave lithotripsy) in 3 renal units. All procedures were done under general anesthesia; using fluoroscopic guidance for localization and standard alkan dilatation followed by rigid nephroscopy and stone extraction with or without stone disintegration. We analyzed our results regarding the site and number of the required access, the intra and postoperative complications, the presence of any residual stones, as well as their location.ResultsThe procedure was completed, using a single access tract in 20 renal units, with the site of puncture being the upper calyx in nine units and the posterior middle calyx in eleven units. Only in one renal unit, two access tracts (an upper and a lower calyceal) were required for completion and a supracostal puncture was required in another case. There was no significant intraoperative bleeding and no blood transfusion was required in any patient. A pelvic perforation occurred in one case, requiring longer PCN (percutaneous nephrostomy) drainage. One patient with infection stones suffered urosepsis postoperatively which was successfully managed. Three cases had residual stones, all located in the renal isthmus, all residuals were un approachable with the rigid instrument; resulting in a overall stone-free rate of 85.7% at discharge.ConclusionPercutaneous nephrolithotomy is generally safe and successful in the management of stones in horseshoe kidneys. However, location of the stones in these patients is crucial to decide the proper tool for optimal stone clearance result.