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Spinos T, Tatanis V, Seitz C, Liatsikos E, Kallidonis P. "Percutaneous Nephrolithotomy (PCNL) versus other treatments for stone management in horseshoe kidneys: A systematic review". Arab J Urol 2024; 22:243-252. [PMID: 39355798 PMCID: PMC11441046 DOI: 10.1080/20905998.2024.2312699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/28/2024] [Indexed: 10/03/2024] Open
Abstract
Urolithiasis represents the most frequent complication of horseshoe kidneys. All known approaches for stone disease management have been reported in these patients, including Extracorporeal Shockwave Lithotripsy, ureteroscopy, Percutaneous Nephrolithotomy, open surgery and laparoscopy. The purpose of this systematic review is to compare Percutaneous Nephrolithotomy with other least-invasive procedures in patients with horseshoe kidneys. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines, PubMed®, Scopus® and Cochrane® primary databases were systematically screened, from inception to 29 May 2023. Both prospective and retrospective comparative studies including patients with horseshoe kidneys and urolithiasis, who underwent Percutaneous Nephrolithotomy and other treatments for stones management, were eligible. Non comparative studies and case series were also included. A total of 10 studies met inclusion criteria and were included in final qualitative synthesis. In total 583 patient underwent Percutaneous Nephrolithotomy and other treatments for stone management in included studies. Stone free rates ranged from 57.1% to 88% for Percutaneous Nephrolithotomy, from 55.6% to 100% for ureteroscopy, from 27.3% to 83.3% for Extracorporeal Shockwave Lithotripsy and was 100% for pyelolithotomy and 71.4% for Percutaneous Nephrolithotomy in combination with ureteroscopy. Although percutaneous Nephrolithotomy was associated with more complications when compared to other treatment modalities, most of them were Grade I or Grade II ones, according to the Clavien-Dindo Classification System. Management of urolithiasis can be efficiently and safely accomplished in almost all cases of horseshoe kidneys. Extracorporeal Shockwave Lithotripsy, ureteroscopy, Percutaneous Nephrolithotomy and pyelolithotomy all represent excellent choices for the treatment of stones in these patients, being feasible, efficient and safe. Percutaneous Nephrolithotomy was associated with the highest stone-free rates, but also with the highest complication rates. Access should be ideally performed via the upper poles. Optimal stone management in patients with horseshoe kidneys depends on stone burden, stone location and surgeon's preference.
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Affiliation(s)
- Theodoros Spinos
- Department of Urology, University of Patras Hospital, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University of Patras Hospital, Patras, Greece
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
- European Association of Urology Section of Urolithiasis (EULIS)
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Hospital, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Lim EJ, Teoh JY, Fong KY, Emiliani E, Gadzhiev N, Gorelov D, Tanidir Y, Sepulveda F, Al-Terki A, Khadgi S, Mahajan A, Ragoori D, Ramalingam G, Mohan VC, Ganpule AP, Kumar S, Castellani D, Monga M, Scoffone C, Vincentini FC, Traxer O, Somani BK, Gauhar V. Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy in anomalous kidneys. Minerva Urol Nephrol 2022; 74:738-746. [PMID: 35147385 DOI: 10.23736/s2724-6051.22.04664-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Endourologic interventions for urolithiasis in patients with anomalous kidneys can be challenging, and comparisons between these interventions are not well studied. We aim to compare the safety, outcomes and complications of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) in patients with urolithiasis in anomalous kidneys. METHODS A propensity score-matched pair analysis (PSM) was performed on pooled patient data from 20 centers. 569 patients with anomalous kidneys (horseshoe kidney [HSK], ectopic kidney, malrotated kidney) and urolithiasis who received either PCNL or RIRS as the primary modality of intervention from 2010 to 2020 were analyzed. Patients were matched based on calculated propensity scores by a regression model using age, sex, comorbidities, stone size, and renal anomaly type as co-variates. Multivariate logistic regression of factors (mode of treatment [PCNL or RIRS], comorbidities, stone size) and their effects on outcomes of stone-free rate (SFR), need to abandon surgery due to intraoperative difficulty, postoperative hematuria and sepsis and were analyzed when applicable. RESULTS After PSM, there were a total of 127 pairs in each group. Overall, PCNL conferred a higher SFR compared to RIRS (OR=3.69, 95% CI 1.91-7.46, P<0.001), particularly in HSK (OR=3.33, 95% CI 1.22-9.99, P=0.023), and ectopic kidneys (OR=18.10, 95% CI 3.62-147.63, P=0.002), with no significant difference in malrotated kidneys. There was no significant difference in postoperative sepsis observed. Surgery was abandoned more often in RIRS than PCNL (6.3% vs. 0%, P=0.014). Although PSM provides a robust analysis due to baseline differences in the unmatched cohorts, this study was limited by an inevitable degree of selection bias. CONCLUSIONS While both modalities are safe and efficacious, PCNL yields better SFR than RIRS in patients with anomalous kidneys, with no difference in postoperative sepsis rates. Patients may benefit from personalized management best carried out in high volume endourology centers.
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Affiliation(s)
- Ee J Lim
- Department of Urology, Singapore General Hospital, Singapore -
| | - Jeremy Y Teoh
- S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Khi Y Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esteban Emiliani
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Dmitry Gorelov
- Department of Endourology, Saint-Petersburg State Medical University Hospital, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fabio Sepulveda
- Department of Urology, Brigadeiro Hospital, São Paulo, Brazil
| | - Abdullatif Al-Terki
- Section of Urology, Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | | | | | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, India
| | | | - Vaddi C Mohan
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India
| | - Arvind P Ganpule
- Department of Urology, Urology Muljibhai Patel Urological Hospital, Nadiad, Gujarat
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Manoj Monga
- Department of Urology, University of California, San Diego, CA, USA
| | | | | | - Olivier Traxer
- Sorbonne University, Department of Urology, Tenon Hospital, Paris, France
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Predictors of Successful Management of Renal Calculus Disease in Horseshoe Kidney. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yi X, Cao D, You P, Xiong X, Zheng X, Jin T, Peng G, Xu H, Liao D, Wei Q, Li H, Yang L, Ai J. Comparison of the Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy and Flexible Ureteroscopy for Treatment of Urolithiasis in Horseshoe Kidney Patients: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:726233. [PMID: 34760915 PMCID: PMC8572974 DOI: 10.3389/fsurg.2021.726233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/20/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Urolithiasis is the most common complication of horseshoe kidney (HK), which can be treated by extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (FURS), and percutaneous nephrolithotomy (PCNL). When comparing treatments of ESWL and FURS, it is unclear which is more efficient and safe. The objective of this study was to compare the efficacy and safety of FURS and SWL for the treatment of urolithiasis in HK patients. Methods: A systematic search of the Web of Science, PubMed, and EMBASE was performed in February 2021. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in each study. Results: Five studies published between 2008 and 2018 were synthesized in the present meta-analysis. The study revealed that FURS compared with SWL had greater initial and overall stone-free rates (SFRs). Risk ratios (RRs) were 2.46 (P < 0.00001) in initial SFRs, 1.36 (P = 0.02) in overall SFRs. No differences were found in the retreatment ratio, RRs were 0.49 (P = 0.43). In addition, no major complications were encountered, and all the complications were mild to moderate. Conclusion: The study demonstrated that FURS and SWL are effective and safe treatments for patients with HK with stones (<20 mm). Moreover, FURS has greater clearance rates and lower complication rates than SWL.
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Affiliation(s)
- Xianyanling Yi
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Pinghong You
- Department of Urology, People's Hospital of Deyang City, Deyang, China
| | - Xingyu Xiong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Peng
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Hang Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dazhou Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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Al Muzrakchi A, Aker LJA, Barah A, Alsherbini A, Omar A. Alternating Biplanar Fluoroscopy in Percutaneous Nephrostomy to Approach Stones in Patients With Horseshoe Kidney: An Institutional Experience. Cureus 2021; 13:e16542. [PMID: 34430150 PMCID: PMC8378839 DOI: 10.7759/cureus.16542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/12/2022] Open
Abstract
This case series aims to evaluate the use of alternating perpendicular biplanar fluoroscopy in percutaneous nephrostomies/percutaneous nephrolithotripsies (PCNs/PCNLs) to approach renal stones in patients with horseshoe kidneys. Between January 2012 and December 2019, PCNs/PCNLs were done for six patients with horseshoe kidneys having renal stones. Skin and renal calyceal entry points were determined by alternating perpendicular biplanar fluoroscopy using a portable C-arm machine in the conventional fluoroscopy unit. The site of renal access, postoperative complications, and residual stones was assessed. The mean age of the patients was 36.8 years. The mean stone size was 6.1 cm (2.1-16.05cm). In five out of six (5/6; 83%) patients, there was one access site. Four patients had their access site through the upper calyx, and one patient had it through the lower calyx. The stone-free rate was four out of six (4/6; 66.6%). One patient had a mild drop in hemoglobin postoperatively. There were no major complications reported. The implementation of alternating biplanar fluoroscopy was found safe and helpful in providing a better appreciation of renal anatomy and stone location in patients with horseshoe kidneys. This technique helps in approaching horseshoe kidney stones in PCN/PCNL without moving the patient or fluoroscopy machine, with a potential decrease in operation time and radiation exposure.
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Affiliation(s)
| | - Loai J A Aker
- Radiology, Hamad Medical Corporation, Doha, QAT.,Radiology, Hamad Medical Corporation, Doha, QAT
| | - Ali Barah
- Radiology, Hamad Medical Corporation, Doha, QAT.,Radiology, Hamad Medical Corporation, Doha, QAT
| | - Ala Alsherbini
- Imaging Department, Royal Melbourne Hospital (Melbourne Health), Melbourne, AUS
| | - Ahmed Omar
- Radiology, Hamad Medical Corporation, Doha, QAT
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Abstract
Horseshoe kidney is the most common congenital renal fusion anomaly with an incidence of 1 in 400–600 individuals. The most common type is fusion at the lower poles seen in greater than 90% of the cases, with the rest depicting fusion at the upper poles, resulting in an inverted horseshoe kidney. Embryologically, there are two theories hypothesizing the genesis of horseshoe kidney – mechanical fusion theory and teratogenic event theory. As an entity, horseshoe kidney is an association of two anatomic anomalies, namely, ectopia and malrotation. It is also associated with other anomalies including vascular, calyceal, and ureteral anomalies. Horseshoe kidney is prone to a number of complications due to its abnormal position as well as due to associated vascular and ureteral anomalies. Complications associated with horseshoe kidney include pelviureteric junction obstruction, renal stones, infection, tumors, and trauma. It can also be associated with abnormalities of cardiovascular, central nervous, musculoskeletal and genitourinary systems, as well as chromosomal abnormalities. Conventional imaging modalities (plain films, intravenous urogram) as well as advanced cross-sectional imaging modalities (ultrasound, computed tomography, and magnetic resonance imaging) play an important role in the evaluation of horseshoe kidney. This article briefly describes the embryology and anatomy of the horseshoe kidney, enumerates appropriate imaging modalities used for its evaluation, and reviews cross-sectional imaging features of associated complications.
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Affiliation(s)
- Hardik U Shah
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Vijayanadh Ojili
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
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Abdeldaeim HM, El Gebaly O, Said M, Zahran AR, Abouyoussif T. Mini percutaneous nephrolithotomy versus retrograde flexible ureterorenoscopy in the treatment of renal calculi in anomalous kidneys. Arch Ital Urol Androl 2021; 93:167-172. [PMID: 34286550 DOI: 10.4081/aiua.2021.2.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To report our single center experience in comparing mini-percutaneous nephrolithotomy versus flexible ureterorenoscopy for management of renal stones up to 2 cm in anomalous kidneys. MATERIALS AND METHODS Records of the last 30 patients with stones less than 2 cm in anomalous kidney treated by mini-percutaneous nephrolithotomy were reviewed and compared to last 30 patients treated by flexible ureterorenoscopy. RESULTS Mean stone size was significantly higher in the minipercutaneous nephrolithotomy group (17.90 mm) than in flexible ureterorenoscopy group (14.97mm) (p < 0.001). Mean operative time (80.33 min vs 56.43 min) and fluoroscopy exposure time (4.49 min vs 0.84 min) were significantly higher in the mini-percutaneous nephrolithotomy group than in the flexible ureterorenoscopy group (p < 0.001). The mean post-operative drop in hemoglobin concentration was significantly higher in the mini-percutaneous nephrolithotomy group (0.47 gm versus 0.2 gm) (p < 0.001). Stone free rate after 12 weeks follow up was not statistically significant between the 2 groups (90% in minipercutaneous nephrolithotomy vs 80% in flexible ureterorenoscopy) (FEp = 0.472). CONCLUSIONS Both modalities were found to be safe and effective for treatment of stones less than 2 cm in anomalous kidneys.
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Affiliation(s)
| | - Omar El Gebaly
- Department of Urology, Alexandria University, Alexandria.
| | - Mostafa Said
- Department of Urology, Alexandria University, Alexandria.
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Tekgül S, Stein R, Bogaert G, Nijman RJM, Quaedackers J, 't Hoen L, Silay MS, Radmayr C, Doğan HS. European Association of Urology and European Society for Paediatric Urology Guidelines on Paediatric Urinary Stone Disease. Eur Urol Focus 2021; 8:833-839. [PMID: 34052169 DOI: 10.1016/j.euf.2021.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/29/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
CONTEXT Paediatric stone disease is an important clinically entity and management is often challenging. Although it is known that the condition is endemic in some geographic regions of the world, the global incidence is also increasing. Patient age and sex; the number, size, location, and composition of the stone; and the anatomy of the urinary tract are factors that need to be taken into consideration when choosing a treatment modality. OBJECTIVE To provide a general insight into the evaluation and management of urolithiasis in the paediatric population in the era of minimally invasive surgery. EVIDENCE ACQUISITION A nonsystematic review of the literature on management of paediatric urolithiasis was conducted with the aim of presenting the most suitable treatment modality for different scenarios. EVIDENCE SYNTHESIS Because of high recurrence rates, open surgical intervention is not the first option for paediatric stone disease, except for very young patients with very large stones in association with congenital abnormalities. Minimally invasive surgeries have become the first option with the availability of appropriately sized instruments and accumulating experience. Extracorporeal shockwave lithotripsy (SWL) is noninvasive and can be carried out as an outpatient procedure under sedation, and is the initial choice for management of smaller stones. However, for larger stones, SWL has lower stone-free rates and higher retreatment rates, so minimally invasive endourology procedures such as percutaneous nephrolithotomy and retrograde intrarenal surgery are preferred treatment options. CONCLUSIONS Contemporary surgical treatment for paediatric urolithiasis typically uses minimally invasive modalities. Open surgery is very rarely indicated. PATIENT SUMMARY Cases of urinary stones in children are increasing. Minimally invasive surgery can achieve high stone-free rates with low complication rates. After stone removal, metabolic evaluation is strongly recommended so that medical treatment for any underlying metabolic abnormality can be given. Regular follow-up with imaging such as ultrasound is required because of the high recurrence rates.
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Affiliation(s)
- Serdar Tekgül
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey.
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre, Groningen, The Netherlands
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre, Groningen, The Netherlands
| | - Lisette 't Hoen
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - M Selcuk Silay
- Department of Urology, Istanbul Biruni University, Istanbul, Turkey
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hasan Serkan Doğan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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Gupta S, Kasim A, Pal DK. Supine tubeless PCNL in horseshoe kidney (a series of cases). Urologia 2021; 89:559-563. [PMID: 34006150 DOI: 10.1177/03915603211015546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Objective of this case series is accurate access to the respective calyx with stone in horseshoe kidney while performing percutaneous nephrolithotmy in supine position. Reducing operative time and anaesthetic morbidity while performing percutaneous nephrolithotomy in horseshoe kidney with nephrolithiasis in supine position. MATERIALS AND METHODS Four patient with one having bilateral renal calculi with horshoe kidney were selected randomly. There were no preference for age, gender; size, location and laterality of stone or BMI. All the patients fit into the AUA guideline criteria for management by percutaneous nephrolithotomy. Preoperative, perioperative and follow up data were collected. RESULTS Four patients with one having bilateral renal calculi underwent supine tubeless PCNL in 1 year in GMSV position. There was no intraoperative, post operative or on follow up complications in any patient. In all the patients stones were cleared completely in single setting. CONCLUSION Supine percutaneous nephrolithotomy in horseshoe kidney is an alternative to the standard prone percutaneous nephrolithotomy in the horseshoe kidney. It provides an additional benefit of performing the procedure in a single position, which is known to reduce total operating time, less anaesthesia related complications and less neuromusculoskeletal injury.
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Affiliation(s)
- Sandeep Gupta
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
| | - Atar Kasim
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research & SSKM Hospital, WB, India
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Chen X, Wang Y, Gao L, Song J, Wang JY, Wang DD, Ma JX, Zhang ZQ, Bi LK, Xie DD, Yu DX. Retroperitoneal vs transperitoneal laparoscopic lithotripsy of 20-40 mm renal stones within horseshoe kidneys. World J Clin Cases 2020; 8:4753-4762. [PMID: 33195643 PMCID: PMC7642540 DOI: 10.12998/wjcc.v8.i20.4753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Horseshoe kidney (HK) with renal stones is challenging for urologists. Although both retroperitoneal and transperitoneal laparoscopic approaches have been reported in some case reports, the therapeutic outcome of retroperitoneal compared with transperitoneal laparoscopic lithotripsy is unknown.
AIM To assess the efficacy of laparoscopic lithotripsy for renal stones in patients with HK.
METHODS This was a retrospective study of 12 patients with HK and a limited number (n ≤ 3) of 20-40 mm renal stones treated with either retroperitoneal or transperitoneal laparoscopic lithotripsy (June 2012 to May 2019). The perioperative data of both groups were compared including operation time, estimated blood loss, postoperative fasting time, perioperative complications and stone-free rate (SFR).
RESULTS No significant difference was observed for age, gender, preoperative symptoms, body mass index, preoperative infection, hydronephrosis degree, largest stone diameter, stone number and isthmus thickness. The mean postoperative fasting time of the patients in the retroperitoneal group and the transperitoneal group was 1.29 ± 0.49 and 2.40 ± 0.89 d, respectively (P = 0.019). There was no significant difference in operation time (194.29 ± 102.48 min vs 151.40 ± 39.54 min, P = 0.399), estimated blood loss (48.57 ± 31.85 mL vs 72.00 ± 41.47 mL, P = 0.292) and length of hospital stay (12.14 ± 2.61 d vs 12.40 ± 3.21 d, P = 0.881) between the retroperitoneal and transperitoneal groups. All patients in both groups had a complete SFR and postoperative renal function was within the normal range. The change in estimated glomerular filtration rate (eGFR) from the preoperative stage to postoperative day 1 in the retroperitoneal group and the transperitoneal group was -3.86 ± 0.69 and -2.20 ± 2.17 mL/(min·1.73 m2), respectively (P = 0.176). From the preoperative stage to the 3-mo follow-up, the absolute change in eGFR values for patients in the retroperitoneal group and the transperitoneal group was -3.29 ± 1.11 and -2.40 ± 2.07 mL/(min·1.73 m2), respectively (P = 0.581).
CONCLUSION Both retroperitoneal and transperitoneal laparoscopic lithotripsy seem to be safe and effective for HK patients with a limited number of 20-40 mm renal stones.
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Affiliation(s)
- Xin Chen
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg 66421, Germany
| | - Jin Song
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jin-You Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Deng-Dian Wang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Jia-Xing Ma
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Zhi-Qiang Zhang
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang-Kuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Dong-Dong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - De-Xin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
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Avci S, Caglayan V, Kilic M, Oner S. Investigation of Factors Related to Percutaneous Nephrolithotomy Failure in Horseshoe Kidneys and Comparison of Three Stone Scoring Systems in Prediction of Outcomes. Urol Int 2020; 105:83-89. [PMID: 32998151 DOI: 10.1159/000510248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to identify factors affecting percutaneous nephrolithotomy (PNL) outcomes among patients with horseshoe kidney (HSK) and assess the predictive accuracy of the Clinical Research Office of the Endourological Society (CROES), Guy's Stone Score (GSS), and S.T.O.N.E. scoring systems. METHODS Data from 98 patients with HSK who underwent PNL between November 2010 and January 2020 were evaluated. Patients were divided into the stone-free (SF) and non-SF groups and compared according to demographic data, stone and surgical characteristics, and stone scoring systems. Multivariate logistic regression analysis was performed to identify factors associated with SF status. RESULTS Among the included patients, 87 were male and 11 were female (mean age: 47.37 ± 14.42 years). The SF rate was 84.7% (83 patients). Group analysis identified GSS (p < 0.001), CROES score (p < 0.001), S.T.O.N.E. score (p = 0.014), stone burden (p = 0.045), and multiplicity (p < 0.001) as factors associated with SF status. Among our cohort, 10 patients developed complications. All scoring systems were significantly correlated with SF status (CROES: r = -0.442, p < 0.001; GSS: r = 0.442, p < 0.001; S.T.O.N.E.: r = 0.250, p = 0.013), while CROES score was identified as an independent factor associated with SF status (95% CI: 0.937-0.987; p = 0.003). CONCLUSIONS PNL is an effective method for treating nephrolithiasis among patients with HSK. Moreover, stone-related factors, such as larger size, multiplicity, and complexity, were associated with procedural failure. Finally, the CROES nomogram was a better predictor of SF status compared with other scoring systems.
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Affiliation(s)
- Sinan Avci
- Department of Urology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Yıldırım/Bursa, Turkey
| | - Volkan Caglayan
- Department of Urology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Yıldırım/Bursa, Turkey,
| | - Metin Kilic
- Department of Urology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Yıldırım/Bursa, Turkey
| | - Sedat Oner
- Department of Urology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Yıldırım/Bursa, Turkey
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12
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Karsli O, Ustuner M, Voyvoda B, Memik O, Halat AO, Ozcan L. A new percutaneous nephrolithotomy position in horseshoe kidney: 45 degrees sided prone. Cent European J Urol 2020; 73:349-354. [PMID: 33133664 PMCID: PMC7587488 DOI: 10.5173/ceju.2020.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION In this study we aimed to determine the effects of the 45 degrees sided prone position to the surgeon's comfort, operation time, fluoroscopy time and complications at the operation of percutaneous nephrolithotomy (PCNL) for the treatment of kidney stone of horseshoe kidney (HK) or rotation anomaly kidney. MATERIAL AND METHODS Thirty eight patients (25 male, 13 female) with renal calculi and HK, underwent PCNL. After the amplatz sheath was inserted into the collecting system, the patients in group 1 (n:20) were taken to the 45 degrees side position to the side of the operation and patients in group 2 (n:18) were operated in classical prone position. Operative data of two groups were compared statistically. RESULTS Mean stone size of group 1 was 557.8 ±244.8 mm3 (188-1175) and group 2 was 590.7 ±172.8 mm3 (423-909) (p = 0.639). In group 1 mean operation time was 78.6 ±21.8 (45-120) minutes and in group 2 was 95.05 ±11.5 (69-120) minutes. The difference for operation time was statistically significant and shorter in the sided group (p = 0.02). CONCLUSIONS The working position of rigid nephroscope is 90 degrees to the body after the dorsomedial or dorsolateral access. In our study the position of patient is laterally sided 45 degree and the flexion on the surgeon's shoulder was minimised. This new position described for PCNL in HK allows comfortable working position for surgeon after upper pole posterior calyces access.
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Affiliation(s)
- Onur Karsli
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Murat Ustuner
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Bekir Voyvoda
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Omur Memik
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Ahmed Omer Halat
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| | - Levent Ozcan
- Health Sciences University, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
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13
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Vicentini FC, Mazzucchi E, Gökçe Mİ, Sofer M, Tanidir Y, Sener TE, de Souza Melo PA, Eisner B, Batter TH, Chi T, Armas-Phan M, Scoffone CM, Cracco CM, Perez BOM, Angerri O, Emiliani E, Maugeri O, Stern K, Batagello CA, Monga M. Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study. J Endourol 2020; 35:979-984. [PMID: 32292038 DOI: 10.1089/end.2020.0128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods: We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values of p < 0.05 were considered significant. Results: We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments ≥4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1 vs 27.7, p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5% vs 2.6% (p = 0.99), 16.9% vs 18.4% (p = 0.99), and 52.5% vs 69.2% (p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5 vs 100 minutes, p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p < 0.001). The prone group had significantly more Clavien 2 complications than the supine (p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion: PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.
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Affiliation(s)
- Fabio Carvalho Vicentini
- Endourology Section, Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Endourology Section, Hospital Brigadeiro, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Endourology Section, Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mehmet İlker Gökçe
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Mario Sofer
- Endourology Section, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tarik Emre Sener
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Brian Eisner
- Kidney Stone Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy Hunt Batter
- Kidney Stone Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Chi
- Department of Urology, UCSF School of Medicine, San Francisco, California, USA
| | - Manuel Armas-Phan
- Department of Urology, UCSF School of Medicine, San Francisco, California, USA
| | | | | | | | - Oriol Angerri
- Department of Urology, Fundació Puigvert, UniversitatAutònoma de Barcelona, Barcelona, Spain
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, UniversitatAutònoma de Barcelona, Barcelona, Spain
| | - Orazio Maugeri
- Department of Urology, Ospedale S Croce e Carle Cuneo, Cuneo, Italy
| | - Karen Stern
- Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | | | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
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14
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Gao X, Fang Z, Lu C, Shen R, Dong H, Sun Y. Management of staghorn stones in special situations. Asian J Urol 2020; 7:130-138. [PMID: 32257806 PMCID: PMC7096693 DOI: 10.1016/j.ajur.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/05/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Staghorn stones have always been a challenge for urologists, especially in some special situations, such as horseshoe kidney, ectopic kidney, paediatric kidney, and solitary kidney. The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications. The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function. Treatment methods for staghorn stones have developed rapidly, such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy and laparoscopy and open surgery. Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon. The decision should be made individually according to the circumstances of the patient. In this review, we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.
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Affiliation(s)
- Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ziyu Fang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chaoyue Lu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rong Shen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hao Dong
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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15
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Keller EX, De Coninck V, Doizi S, Traxer O. The role of ureteroscopy for treatment of staghorn calculi: A systematic review. Asian J Urol 2019; 7:110-115. [PMID: 32257803 PMCID: PMC7096690 DOI: 10.1016/j.ajur.2019.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/16/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Objective To define the role of ureteroscopy for treatment of staghorn calculi. Methods A systematic review was conducted using the Scopus and Medline databases. Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included. Results In five studies on ureteroscopic monotherapy, stone-free rate (SFR) ranged from 33% to 93%, with a maximum four ureteroscopy sessions per patient and no major complications. Endoscopic combined intrarenal surgery (ECIRS) was compared with percutaneous nephrolithotomy (PNL) in two studies and reached significantly higher SFR (88%-91% vs. 59%-65%) and lower operative times (84-110 min vs. 105-129 min). The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%-89%. One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi, with a SFR of 92%. Conclusion Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi. Ureteroscopy is also particularly suitable for clearance of residual stones. In specific cases, ureteroscopy may become the sole applicable therapeutic option to staghorn calculi. Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.
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Affiliation(s)
- Etienne Xavier Keller
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France.,Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent De Coninck
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France.,Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Steeve Doizi
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France
| | - Olivier Traxer
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France
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16
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Kartal I, Çakıcı MÇ, Selmi V, Sarı S, Özdemir H, Ersoy H. Retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of stones in horseshoe kidney; what are the advantages and disadvantages compared to each other? Cent European J Urol 2019; 72:156-162. [PMID: 31482022 PMCID: PMC6715073 DOI: 10.5173/ceju.2019.1906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/26/2019] [Accepted: 05/28/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction Kidney stones occur more frequently in patients with a horseshoe kidney (HSK) anomaly. Abnormal anatomy may make the stone removal procedures more difficult. Therefore we aimed to evaluate and compare retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) for the treatment of renal stones in the HSK anomaly. Material and methods In this descriptive study, patients with HSK anomaly who underwent RIRS and PCNL procedures were retrospectively evaluated. Demographic and renal stone characteristics, success and complications associated with the surgical methods were compared across patients. Results A total of 49 patients were evaluated, 28 underwent RIRS and 21 underwent PCNL. No differences were determined between the groups concerning the demographics of patients and stone characteristics. A single session and final stone-free rate was 71.4% and 85.7% in RIRS, 81% and 90.5% in PCNL (both p ≥0.05). However, RIRS had more re-treatment rate, while its mean length of hospital stay was shorter than PCNL (p = 0.035, p = 0.001). While no differences were detected between the associated complication rates, more of the complications encountered in the PCNL group were of a serious nature. Conclusions In the HSK anomaly, renal stones can be treated with RIRS and PCNL procedures with high success. With its minimal morbidity, low complication rates and the minor character of the associated complications, the RIRS procedure can sometimes be preferred to avoid complications related to PCNL in HSK anomaly with big sized kidney stones.
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Affiliation(s)
- Ibrahim Kartal
- Health Science University, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Mehmet Çağlar Çakıcı
- Medeniyet University, Faculty of Medicine, Göztepe Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Volkan Selmi
- Bozok University, Faculty of Medicine, Department of Urology, Yozgat, Turkey
| | - Sercan Sarı
- Bozok University, Faculty of Medicine, Department of Urology, Yozgat, Turkey
| | - Harun Özdemir
- Avcılar State Hospital, Department of Urology, Istanbul, Turkey
| | - Hamit Ersoy
- Health Science University, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Department of Urology, Ankara, Turkey
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17
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Mourmouris P, Berdempes M, Markopoulos T, Lazarou L, Tzelves L, Skolarikos A. Patient positioning during percutaneous nephrolithotomy: what is the current best practice? Res Rep Urol 2018; 10:189-193. [PMID: 30464930 PMCID: PMC6214409 DOI: 10.2147/rru.s174396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is the gold standard procedure for treatment of large stones and complex kidney disorders, but its morbidity remains the highest among stone treatment procedures. In pursuit of minimizing complication rates, surgeons have developed different variations of the classic prone position in which PCNL is usually performed; one among them is supine position. In this study, we review the literature and present all available evidence on different variations in positioning during PCNL, in an effort to identify if there is a position that can minimize the morbidity of this procedure.
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Affiliation(s)
- Panagiotis Mourmouris
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Marinos Berdempes
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Titos Markopoulos
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Lazaros Lazarou
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Lazaros Tzelves
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
| | - Andreas Skolarikos
- Second Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece,
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18
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Al Otay A, Sarhan O, El-Tholoth HS, Alhelaly A, Al Akrash H, Al Ghanbar M, Al Bedaiwi K, Nakshabandi Z, Obeid A. Different managements of horseshoe kidney stones, any difference in the outcome? Urol Ann 2018; 10:287-290. [PMID: 30089987 PMCID: PMC6060601 DOI: 10.4103/ua.ua_116_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Abdulhakim Al Otay
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Osama Sarhan
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hossam S El-Tholoth
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Alhelaly
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hamad Al Akrash
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mustafa Al Ghanbar
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khaled Al Bedaiwi
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ziad Nakshabandi
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Obeid
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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19
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Hong Y, Xu Q, Huang X, Zhu Z, Yang Q, An L. Ultrasound-guided minimally invasive percutaneous nephrolithotomy in the treatment of pediatric patients <6 years: A single-center 10 years' experience. Medicine (Baltimore) 2018; 97:e0174. [PMID: 29595647 PMCID: PMC5895361 DOI: 10.1097/md.0000000000010174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Owing to the fragile kidney and relative small collecting system of pediatric patients, urologists were always reluctant to treat pediatric urolithiasis with PCNL. Here we conduct a study to assess the effectiveness and safety of pediatric patients with renal calculi <6 years.A total of 88 pediatric patients (99 kidney units) <6 years underwent the ultrasound (US)-guided minimally invasive percutaneous nephrolithotomy in our institute from March 2006 to April 2016. The mean age was 30.9 months (range, 7-72 months). The mean stone size was 19.5 mm (range, 10-50 mm). The group included single stone in 35 kidney units, upper ureteral stone in 12 kidney units, multiple stone in 43 kidney units, and staghorn stone in 9 kidney units. The procedure of puncture and dilation were guided by US solely.The mean operation time was 52.3 minutes (range, 15-140 minutes). The mean postoperative length of stay was 6.0 days (3-16 days). Besides, the initial stone free rate (SFR) was 90.9% (90/99) and the final SFR was 96.0% (95/99). The mean hemoglobin drop was 10.9 g/L (range, 1-25 g/L). Postoperative complications occurred in 12 patients including fever in 11 cases and active pleural effusion in 1 case.The US-guided MPCNL is an effective and safety procedure to treat pediatric patients with stone <6 years.
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20
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Pawar AS, Thongprayoon C, Cheungpasitporn W, Sakhuja A, Mao MA, Erickson SB. Incidence and characteristics of kidney stones in patients with horseshoe kidney: A systematic review and meta-analysis. Urol Ann 2018; 10:87-93. [PMID: 29416282 PMCID: PMC5791465 DOI: 10.4103/ua.ua_76_17] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction The horseshoe kidney (HSK) is the most common type of renal fusion anomaly. The incidence and characteristics of kidney stones in patients with HSK are not well studied. The aim of this meta-analysis was to evaluate the incidence and types of kidney stones in patients with HSK. Methods A systematic literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the databases' inception through November 2016. Studies assessing the incidence and types of kidney stones in patients with HSK were included. We applied a random-effects model to estimate the incidence of kidney stones. The study protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42016052037). Results A total of 14 observational studies with 943 patients (522 adults and 421 pediatric) with HSK were enrolled. The estimated pooled incidence of kidney stones was 36% (95% confidence interval [CI], 15%-59%) in adults with the HSK. Kidney stones were less common in pediatric patients with HSK with an estimated pooled incidence of 3% (95% CI, 2%-5%). The mean age of adult stone formers with HSK was 44.9 ± 6.2 years, and 75% were males. Within reported studies, 89.2% of kidney stones were calcium-based stones (64.2% calcium oxalate [CaOx], 18.8% calcium phosphate [CaP], and 6.2% mixed CaOx/CaP), followed by struvite stones (4.2%), uric acid stones (3.8%), and others (2.8%). Conclusions Kidney stones are very common in adult patients with HSK with an estimated incidence of 36%. Calcium-based stones are the most prevalent kidney stones in adults with HSKs. These findings may impact the prevention and clinical management of kidney stones in patients with HSK.
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Affiliation(s)
- Aditya S Pawar
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Wisit Cheungpasitporn
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Ankit Sakhuja
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A Mao
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Stephen B Erickson
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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21
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Satav V, Sabale V, Pramanik P, Kanklia SP, Mhaske S. Percutaneous nephrolithotomy of horseshoe kidney: Our institutional experience. Urol Ann 2018; 10:258-262. [PMID: 30089983 PMCID: PMC6060603 DOI: 10.4103/ua.ua_152_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To review our success in PCNL for managing large horse shoe kidney stones as primary treatment. Method Between 2012 and 2016, a total of 23patients (24 renal units) underwent percutaneous renal surgery for stone dieses in horseshoe kidneys. Indications were HSK with stone more than 1 cm in size and failed ESWL. Results Mean age was 35.60 ± 10.10 years out of which 18 were males and 5 females. One patient had stone in both kidneys. Mean stone size was 22.03 ± 10.33 mm. Access site was upper calyceal and subcostal in all patients. In 2 patients an extra middle calyceal puncture were used for total clearance (8.69%). Mean operation time was 67.22 ± 7.63 minutes. One patient with staghorn stone was converted to open surgery because of inaccessibility of the stone and complexity of the renal calyceal system. Post operatively, 2 renal units with residual stone more than 8mm were cleared with ESWL. Complete clearance was achieved in 21 renal units with PCNL (87.50%). There was no significant intra operative complication. Post operatively 2 patients developed fever which was treated conservatively(clavien grade I). Conclusion PCNL can be recommended as first line of management in the treatment of horseshoe kidneys with large stone burden considering its higher clearance rate and minimal complications.
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Affiliation(s)
- Vikram Satav
- Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Vilas Sabale
- Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Prasun Pramanik
- Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Sharad P Kanklia
- Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Sunil Mhaske
- Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
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Sohail N, Albodour A, Abdelrahman KM, Bhatti KH. Supine percutaneous nephrolithotomy in horseshoe kidney. J Taibah Univ Med Sci 2017; 12:261-264. [PMID: 31435248 PMCID: PMC6694933 DOI: 10.1016/j.jtumed.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 11/26/2022] Open
Abstract
We report a case of a 45-year-old male who presented with recurrent left loin pain of three months' duration. A CT scan of his abdomen and pelvis showed a horseshoe kidney with two stones in the middle and lower calyx of the left kidney, each stone measuring approximately 1.5 cm in size. The patient had a past history of several unsuccessful attempts of extracorporeal shockwave lithotripsy (ESWL) on the same side. We treated the patient successfully by performing a percutaneous nephrolithotomy (PCNL) in the supine position that resulted in complete stone clearance. In addition, we report a shorter procedure time and hospital stay with no perioperative or post-operative complications.
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Affiliation(s)
- Nadeem Sohail
- Urology Section, Alkhor Hospital, Hamad Medical Corporation, Doha, Qatar
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Prakash G, Sinha RJ, Jhanwar A, Bansal A, Singh V. Outcome of percutaneous nephrolithotomy in anomalous kidney: Is it different? Urol Ann 2017; 9:23-26. [PMID: 28216924 PMCID: PMC5308032 DOI: 10.4103/0974-7796.198836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Various anomalous kidneys such as horseshoe kidney, crossed ectopic kidney, simple ectopic kidney, pelvic ectopic kidney, kidney with duplex system, and malrotated kidney are frequently associated with stone disease. Percutaneous nephrolithotomy (PCNL) is a challenging procedure in these patients because of abnormal orientation of kidney. PATIENTS AND METHODS Since 2005-2015, 86 patients underwent PCNL for stone removal in anomalous kidneys. Stone characteristics, type of calyceal puncture, number of punctures, need of relook procedures, mean hemoglobin drop, blood transfusion, mean operative time complications, mean hospital stay, stone free rate, and auxiliary procedure were analyzed. RESULTS Totally 91 sessions of PCNL was done in 86 patients including five of horseshoe kidney who had bilateral stone disease. Mean age, duration of symptoms, stone size, and hospital stay was 29.6 ± 12.6 years, 2.18 ± 1.41 years, 4.40 ± 1.16, and 4.17 ± 2.11 days, respectively. Sixteen patients underwent relook procedure, out of which only 6 could have complete stone clearance. CONCLUSION PCNL in anomalous kidney is a safe and feasible procedure similar to normally located kidney, but requires careful preoperative planning and intra- and post-operative vigilance.
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Affiliation(s)
- Gaurav Prakash
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Janak Sinha
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ankur Jhanwar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ankur Bansal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Khadgi S, Shrestha B, Ibrahim H, Shrestha S, ElSheemy MS, Al-Kandari AM. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study. Urolithiasis 2016; 45:407-414. [DOI: 10.1007/s00240-016-0926-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
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Jiang K, Tang K, Xu H, Chen H, Chen Z. Retroperitoneoscopy Technique-Assisted Percutaneous Nephrolithotomy for Complexity Horseshoe Kidney with Renal Stones. Urol Int 2016; 97:285-291. [PMID: 27450075 DOI: 10.1159/000446120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of retroperitoneoscopy technique-assisted percutaneous nephrolithotomy (PCNL) used in the treatment of complexity horseshoe kidney (HSK) with renal stones. METHODS Between January 2012 and April 2015, 5 patients with renal stones in complexity HSK underwent retroperitoneoscopy technique-assisted PCNL. The perioperative data analyzed, included operation time, blood loss, incidence of complication rate, the stone-free rate (SFR), and so on. RESULTS All the patients successfully completed the operation without need for an open surgery. The mean operative time in which this procedure was done was 77.5 ± 20.6 min, the mean hemoglobin that was reduced was 2.5 ± 0.8 g/dl, the mean time to remove nephrostomy tube and retroperitoneal tube were 3.0 ± 1.0, 3.5 ± 1.0 days, respectively. The mean hospital stay was 7.0 ± 1.5 days. The SFR of all the patients was 80% (4/5). One patient who had residual stones (6 × 5 mm) in the middle pole underwent additional shock wave lithotripsy after the operation and no serious perioperative complications were noticed. Study limitations include small sample size and short follow-up time. CONCLUSIONS Retroperitoneoscopy technique-assisted PCNL is a feasible, safe, and an effective alternative to laparoscopic pyelolithotomy for treating complexity HSK with renal stones, especially in a situation where the HSK is tightly wrapped by the surrounding organs.
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Affiliation(s)
- Kehua Jiang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ding J, Huang Y, Gu S, Chen Y, Peng J, Bai Q, Ye M, Qi J. Flexible Ureteroscopic Management of Horseshoe Kidney Renal Calculi. Int Braz J Urol 2016; 41:683-9. [PMID: 26401860 PMCID: PMC4756996 DOI: 10.1590/s1677-5538.ibju.2014.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 10/23/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy of flexible ureteroscope (F-URS) combined with holmium laser lithotripter in treating renal calculi in horseshoe kidney. MATERIALS AND METHODS From November 2010 to December 2013, the medical history and charts of sixteen patients (mean age 42.9 ± 11.6 years, range 26-66 years), including 13 males and 3 females were analyzed retrospectively. Mean stone burden was 29 ± 8 mm (range 17-42 mm2). Mean stone digitized surface area (DSA) was 321 ± 94 mm2 (range 180-538 mm2). Under spinal anesthesia in a modified lithotomy position with the head down, rigid ureteroscope was placed firstly into the ureter to reach the level of the pelvis, a zebra guide wire was inserted and following the removal of the rigid ureteroscope, an ureteral access sheath was positioned along the guide wire, then passed the URF P-5 flexible ureteroscope into the renal cavities over the guidewire. After locating the stones, holmium laser lithotripsy was performed. RESULTS The average operative time was 92 ± 16 minutes (range 74-127 min.). No major complications were encountered. Ten patients obtained stone-free status with one session, four obtained stone-free status after two sessions. Single session stone-free rate was 62.5%, overall stone-free rate was 87.5%. Two patients have small residual stones in the lower pole. CONCLUSIONS F-URS combined with holmium laser lithotripter and nitinol basket, is safe and effective in dealing with moderate stone diameter (<30 mm) in HSKs with high clearance rates and low complication rates.
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Affiliation(s)
- Jie Ding
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunteng Huang
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siping Gu
- Micro-Invasive Surgery Center, Shishi Overseas Chinese Hospital, Fujian, China
| | - Yifan Chen
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Peng
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Bai
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Ye
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Purkait B, Sankhwar SN, Kumar M, Patodia M, Bansal A, Bhaskar V. Do Outcomes of Percutaneous Nephrolithotomy in Horseshoe Kidney in Children Differ from Adults? A Single-Center Experience. J Endourol 2016; 30:497-503. [PMID: 26791336 DOI: 10.1089/end.2015.0794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare the efficacy, outcome, and safety of percutaneous nephrolithotomy (PCNL) for stones in horseshoe kidney (HSK) in children compared with adults. METHODS 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. RESULTS 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. DISCUSSION 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. CONCLUSIONS 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.
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Affiliation(s)
- Bimalesh Purkait
- Department of Urology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | | | - Manoj Kumar
- Department of Urology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Madhusudan Patodia
- Department of Urology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Ankur Bansal
- Department of Urology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Ved Bhaskar
- Department of Urology, King George's Medical University , Lucknow, Uttar Pradesh, India
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Blackburne AT, Rivera ME, Gettman MT, Patterson DE, Krambeck AE. Endoscopic Management of Urolithiasis in the Horseshoe Kidney. Urology 2016; 90:45-9. [PMID: 26772644 DOI: 10.1016/j.urology.2015.12.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess the endourologic outcomes of patients diagnosed with a horseshoe kidney (HK) and symptomatic urolithiasis. METHODS A retrospective review was performed of patients diagnosed with an HK who underwent endoscopic management from 2002 to present. RESULTS We identified 45 patients with 64 stone-bearing moieties who underwent 56 procedures, of which 31 (69%) were male. Mean age was 49.4 years (23-78) and mean stone size was 1.6 cm (0.2-5.7). Of the 64 moieties, 37 (58%) underwent percutaneous nephrolithotomy (PCNL), 25 (39%) underwent ureteroscopy (URS), and 2 (3%) underwent extracorporal shockwave lithotripsy (SWL). More than one access was utilized in 2 (5.7%) moieties undergoing PCNL. Additional procedures were required in 10 (28.5%) PCNL patients, of which 7 were URS, 2 were secondary PCNL, and 1 sandwich therapy with SWL and PCNL. Stone-free rate by moiety was 81.1% for PCNL, 84% for URS, and 50% for SWL. Postoperative complications occurred in 3 patients in the PCNL group, including readmission for pain and complicated urinary tract infection. With a mean follow-up of 20.5 months (range 0-118 months), stone recurrence was noted in 7 (16%) patients with a total of 11 events. Calcium oxalate was the most common stone type and 20/24 (83%) of patients with metabolic evaluations were found to have at least one abnormality. CONCLUSION After careful consideration of the anatomy, individuals with HK and symptomatic urolithiasis can be managed safely by a variety of endoscopic approaches with excellent outcomes; however, secondary procedures and recurrence are common.
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Ishii H, Rai B, Traxer O, Kata SG, Somani BK. Outcome of ureteroscopy for stone disease in patients with horseshoe kidney: Review of world literature. Urol Ann 2015; 7:470-4. [PMID: 26692667 PMCID: PMC4660698 DOI: 10.4103/0974-7796.157969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction and Objectives: The management of urolithiasis in patients with horseshoe kidney (HSK) is difficult. Stone formation occurred in 1:5 patients with HSK due to impaired urinary drainage and infections. Percutaneous nephrolithotomy and shock wave lithotripsy can be technically challenging due to altered anatomy. Materials and Methods: We conducted a systematic review of the literature to look at the role of ureteroscopy for stone management in these patients. We searched MEDLINE, PubMed and the Cochrane Library from January 1990 to April 2013 for results of ureteroscopy and stone treatment in HSK patients. Inclusion criteria were all English language articles reporting on ureteroscopy in patients with HSK. Data were extracted on the outcomes and complications. Results: A total of 3 studies was identified during this period. Forty-one patients with HSK underwent flexible ureteroscopy and stone treatment. The mean age was 42 with a male:female ratio nearly 3:1. The mean stone size was 16 mm (range: 3-35 mm). The mean operating time was 86 min with multiple stones seen in 15 patients. All 41 patients had a ureteral access sheath used and flexible ureteroscopy and holmium laser fragmentation done. Thirty-two (78%) patients were stone-free with a mean hospital stay of 1-day. Minor complications (Clavien I or II) were seen in 13 (32%) of which 6 had stent discomfort, 3 needed intravenous antibiotics for <24 h, 3 had hematuria of which 2 needed blood transfusion and one had pyelonephritis needing re-admission and antibiotics. There were no major complications found in the review. Conclusions: Retrograde stone treatment using ureteroscopy and lasertripsy in HSK patients can be performed with good stone clearance rate, but with a slightly higher complication rate. This procedure should, therefore, be done in high volume stone center with an experienced stone surgeon/team.
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Affiliation(s)
- Hiro Ishii
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Bhavan Rai
- Department of Urology, Ninewells Hospital, Dundee, Scotland
| | - Olivier Traxer
- Department of Urology, University Pierre et Marie Curie Paris 6, Paris, France
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Gamal W, Moursy E, Rashed EN, Ahmed M, Farag F. Colon Radiological Delineation Technique Prior to Percutaneous Nephrolithotomy in Patients With Horseshoe Kidney. Urology 2015. [PMID: 26210668 DOI: 10.1016/j.urology.2015.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To develop a technique that helps avoid colonic injury during percutaneous nephrolithotomy (PCNL) in these patients. PATIENTS AND METHODS PCNL was prospectively performed in a cohort of adults with renal stones in a horseshoe kidney (HSK). PCNLs were done using a standardized technique in prone position in all patients. The colon was radiologically delineated by injecting air-through a catheter in the anal canal-to help localize its position in relation to the pelvicalyceal system (PCS). Patients were observed in hospital for 48 hours postoperatively to detect any potential complications related to the PCNL or to the colon insufflation modification. RESULTS Thirteen adult patients (11 men and 2 women) with renal stones in a HSK were included in the study. The colon was well radiologically delineated with air in all cases. The PCS was successfully accessed, subcostally, with a single access at the upper calyx in 11 cases and multiple accesses in 2 cases. The colon was in the way of the puncture in 2 cases in which we used a more medial access and the colon was successfully avoided. Stones were completely removed during the PCNL in 11 of the 13 cases (84.6%). One case necessitated intraoperative blood transfusion. No other complications were reported by any of the patients who were discharged home after 48 hours. CONCLUSION Colonic radiological delineation technique is helpful in accessing the PCS quickly, saving the colon, and causing no discomfort to patients with renal stones in a HSK.
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Affiliation(s)
- Wael Gamal
- Department of Urology, Sohag University Hospital, Sohag, Egypt.
| | - Essam Moursy
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - El Nisr Rashed
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Mmdouh Ahmed
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt
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Purkait B, Goel A. Factors Affecting Outcomes of Percutaneous Nephrolithotomy in Horseshoe Kidneys. Urology 2015; 85:1523-4. [PMID: 26099897 DOI: 10.1016/j.urology.2015.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 01/26/2015] [Accepted: 02/03/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Bimalesh Purkait
- Department of Urology, King George's Medical University, Lucknow, India
| | - Apul Goel
- Department of Urology, King George's Medical University, Lucknow, India
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Factors Affecting Outcomes of Percutaneous Nephrolithotomy in Horseshoe Kidneys. Urology 2014; 84:1290-4. [DOI: 10.1016/j.urology.2014.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/16/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022]
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Violette PD, Dion M, Tailly T, Denstedt JD, Razvi H. Percutaneous Nephrolithotomy in Patients with Urinary Tract Abnormalities. J Endourol 2014; 28:1448-54. [DOI: 10.1089/end.2014.0239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philippe D. Violette
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Marie Dion
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Thomas Tailly
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John D. Denstedt
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Outcomes of retrograde flexible ureteroscopy and laser lithotripsy for stone disease in patients with anomalous kidneys. Urolithiasis 2014; 43:77-82. [PMID: 25161087 DOI: 10.1007/s00240-014-0713-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/11/2014] [Indexed: 12/12/2022]
Abstract
Due to the presence of structural and anatomical differences that accompany anomalous kidneys, currently available endourological modalities such as SWL and PNL may be insufficient, or additional laparoscopic assistance may be required. The present study aims to evaluate the efficacy and safety of retrograde flexible ureterorenoscopic stone treatment in patients with kidney anomalies. Over the last 3 years, 25 patients with renal stones in anomalous kidneys were consecutively treated by flexible ureterorenoscopy and holmium:YAG laser lithotripsy. Among the 25 patients, fiberoptic or digital flexible ureterorenoscopies were performed for the management of horseshoe kidneys (n = 3), cross-fused ectopic kidney (n = 1), renal ectopies [n = 13; associated with pelvic (n = 6) or lumbar kidneys (n = 7)], renal malrotations (n = 4), and duplicate ureters (n = 4). For lithotripsy, 200 or 273 µm probes were used, and for stone retraction 1.3-1.9 Fr ZeroTip baskets were used. Success was defined as the complete absence of stones as evaluated with a CT scan 1 month after the operation. The mean patient age was 39.4 ± 15.75 years, and the mean stone size was 194.64 ± 103.93 mm(2) (range 50-393). Complete stone clearance was achieved in 16 patients (64%) after a single session. Seven of the patients with residual stones underwent a second session and the remaining three patients were subsequently treated with SWL. The overall complete clearance rate was 88% (22 patients) with ancillary procedures. There were no serious postoperative complications except for one case (4%) of urosepsis. Flexible ureterorenoscopy with holmium laser lithotripsy is a safe option for the treatment of renal stones in anomalous kidneys with satisfactory success rates.
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Violette P, Dion M, Tailly T, Denstedt JD, Razvi H. Percutaneous Nephrolithotomy in Patients with Urinary Tract Abnormalities. J Endourol 2014. [DOI: 10.1089/end.2014.0239.ecc14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Stones in abnormal situations present a management conundrum to the urologist. Many of these situations are relatively rare and literature is scanty on the appropriate management. We review the current literature on the management of stones in the setting of pregnancy, calyceal diverticulum, urinary diversions, pelvic kidneys, transplant kidneys, autosomal dominant polycystic kidney disease, horseshoe kidneys, and other renal anomalies. The aims of treatment are complete stone-free status. The modality of treatment should be individualized to the size and location of stone and type of abnormal situation confronted.
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Affiliation(s)
- Yung K Tan
- Department of Urology, Columbia University Medical Center, New York, NY 10032, USA
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Al-Marhoon MS. Staghorn calculus in a horseshoe kidney. Sultan Qaboos Univ Med J 2013; 12:534-6. [PMID: 23275856 DOI: 10.12816/0003185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/22/2012] [Accepted: 05/08/2012] [Indexed: 11/27/2022] Open
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What the Radiologist Needs to Know About Urolithiasis: Part 1???Pathogenesis, Types, Assessment, and Variant Anatomy. AJR Am J Roentgenol 2012; 198:W540-7. [DOI: 10.2214/ajr.10.7285] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tefekli A, Tepeler A, Akman T, Akçay M, Baykal M, Karadağ MA, Muslumanoglu AY, de la Rosette J. The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones. ACTA ACUST UNITED AC 2012; 40:549-55. [PMID: 22307365 DOI: 10.1007/s00240-012-0463-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 01/19/2012] [Indexed: 12/30/2022]
Abstract
The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4 cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p > 0.05). The mean operation time was 138.40 ± 51.19 (range 70-240) min in LPL group as compared to 57.92 ± 21.12 (range 40-110) min in PNL group (p < 0.0001). There was one (3.8%) open conversion in the LPL group due to dense perirenal adhesions making the dissection difficult. The ureteropelvic junction (UPJ) obstruction concomitant to pelvic stones was successfully repaired laparoscopically in two cases. The mean drop in postoperative hemoglobin level was 0.9 ± 0.6 (range 0-2) g/dl in LPL group and 1.7 ± 1.1 (range 0-4) g/dl in PNL group (p = 0.024). Hospitalization was significantly shorter in PNL than LPL group (p = 0.0001). Stone-free rates were similar. Laparoscopic pyelolithotomy is associated with a longer operation time, is more invasive, and requires more skills when compared to PNL. However, LPL is associated with less blood loss. Laparoscopic pyelolithotomy is indicated for congenitally anomalous kidneys and especially in patients with concomitant UPJ.
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Affiliation(s)
- Ahmet Tefekli
- Department of Urology, Haseki Teaching and Research Hospital, 34360 [corrected] Istanbul, Turkey.
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El-Nahas AR, Shokeir AA. Minimally Invasive Treatment of Calculi in Renal Anomalies. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Osther PJ, Razvi H, Liatsikos E, Averch T, Crisci A, Garcia JL, Mandal A, de la Rosette, on behalf of the CRO J. 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. J Endourol 2011; 25:1627-32. [DOI: 10.1089/end.2011.0146] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Palle Jörn Osther
- Department of Urology, Fredericia Hospital, University of Southern Denmark, Fredericia, Denmark
| | - Hassan Razvi
- Division of Urology, The University of Western Ontario, London, Ontario, Canada
| | | | - Timothy Averch
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alfonso Crisci
- Department of Urology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Juan Lòpez Garcia
- Department of Urology, Complejo, Hospitalario Donostia, San Sebastian, Guipuzkoa, Spain
| | - Arup Mandal
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Seitz C, Desai M, Häcker A, Hakenberg OW, Liatsikos E, Nagele U, Tolley D. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 2011; 61:146-58. [PMID: 21978422 DOI: 10.1016/j.eururo.2011.09.016] [Citation(s) in RCA: 280] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/15/2011] [Indexed: 11/29/2022]
Abstract
CONTEXT Incidence, prevention, and management of complications of percutaneous nephrolitholapaxy (PNL) still lack consensus. OBJECTIVE To review the epidemiology of complications and their prevention and management. EVIDENCE ACQUISITION A literature review was performed using the PubMed database between 2001 and May 1, 2011, restricted to human species, adults, and the English language. The Medline search used a strategy including medical subject headings (MeSH) and free-text protocols with the keywords percutaneous, nephrolithotomy, PCNL, PNL, urolithiasis, complications, and Clavien, and the MeSH terms nephrostomy, percutaneous/adverse effects, and intraoperative complications or postoperative complications. EVIDENCE SYNTHESIS Assessing the epidemiology of complications is difficult because definitions of complications and their management still lack consensus. For a reproducible quality assessment, data should be obtained in a standardized manner, allowing for comparison. An approach is the validated Dindo-modified Clavien system, which was originally reported by seven studies. No deviation from the normal postoperative course (Clavien 0) was observed in 76.7% of PNL procedures. Including deviations from the normal postoperative course without the need for pharmacologic treatment or interventions (Clavien 1) would add up to 88.1%. Clavien 2 complications including blood transfusion and parenteral nutrition occurred in 7%; Clavien 3 complications requiring intervention in 4.1.%; Clavien 4, life-threatening complications, in 0.6%; and Clavien 5, mortality, in 0.04%. High-quality data on complication management of rare but potentially debilitating complications are scarce and consist mainly of case reports. CONCLUSIONS Complications after PNL can be kept to a minimum in experienced hands with the development of new techniques and improved technology. A modified procedure-specific Clavien classification should be established that would need to be validated in prospective trials.
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Affiliation(s)
- Christian Seitz
- Department of Urology, St. John of God Hospital, Teaching Hospital of the Medical University of Vienna, Austria.
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Skolarikos A, Binbay M, Bisas A, Sari E, Bourdoumis A, Tefekli A, Muslumanoglu AY, Deliveliotis C. Percutaneous nephrolithotomy in horseshoe kidneys: factors affecting stone-free rate. J Urol 2011; 186:1894-8. [PMID: 21944093 DOI: 10.1016/j.juro.2011.06.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE We report a 2-center study of factors affecting the stone-free rate after percutaneous nephrolithotomy in horseshoe kidneys. MATERIALS AND METHODS The postoperative stone-free rate after percutaneous nephrolithotomy was evaluated in 47 male and 11 female patients with horseshoe kidneys. All data were collected prospectively. Patient and procedure related factors predicting the stone-free rate were analyzed by univariate and multivariate tests. RESULTS The mean ± SD stone burden was 7.62 ± 7.18 cm(2) (range 1 to 45) and the stone was larger than 10 cm(2) in 14 patients (24.1%). Complex stones and staghorn stones were present in 21 (36.2%) and 19 patients (32.7%), respectively. The overall stone-free rate was 65.5%. Complex stones (p = 0.01), stone burden greater than 5 cm(2) (p = 0.013), stone burden greater than 10 cm(2) (p = 0.012), multiple stones (p = 0.006) and staghorn stones (p <0.001) were related to adverse outcomes on univariate analysis. Logistic regression analysis revealed that staghorn calculi was the only factor that significantly predicted the stone-free rate (p = 0.002). A patient with staghorn calculi in the horseshoe kidney was 45 times more likely to have a lower stone-free rate after percutaneous nephrolithotomy than a patient without staghorn calculi in the horseshoe kidney. CONCLUSIONS Stone parameters are important when treating calculi in horseshoe kidneys. Staghorn calculi are associated with a lower stone-free rate after percutaneous nephrolithotomy.
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Affiliation(s)
- Andreas Skolarikos
- Second Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens, Greece.
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Rao RK, Ranganath MS, Prasad TK. Synchronized bilateral percutaneous nephrolithotripsy in a horseshoe kidney. Indian J Urol 2011; 24:120-2. [PMID: 19468376 PMCID: PMC2684246 DOI: 10.4103/0970-1591.38619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Stone management in horseshoe kidneys is challenging: percutaneous nephrolithotripsy is a safe and effective procedure in the treatment of large stones within horseshoe kidneys. Simultaneous bilateral PCNL has been described with a single surgeon operating sequentially on one renal unit following the other under the same anesthetic. We describe synchronized bilateral PCNL by two operating teams in tandem for a patient with bilateral stag horn calculi associated with a horseshoe kidney.
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Affiliation(s)
- R Krishna Rao
- Urology Department, Vikram Hospital and Heart Care, Mysore, Karnataka, India
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Kara C, Resorlu B, Ozyuvali E, Unsal A. Is percutaneous nephrolithotomy suitable for patients with scoliosis: single-center experience. Urology 2011; 78:37-42. [PMID: 21256569 DOI: 10.1016/j.urology.2010.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 11/03/2010] [Accepted: 11/03/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To present our experience with percutaneous nephrolithotomy (PCNL) for treating urolithiasis in patients with scoliosis. METHODS We retrospectively reviewed the records of 5 patients with congenital scoliosis who had undergone PCNL. The demographic data, number and location of access sites, hemoglobin values, stone analyses, and complications were studied. Of the 5 patients, 3 had a history of failed shock wave lithotripsy, and 2 had undergone stone intervention in same kidney. All procedures were performed with the patient in the prone position after retrograde ureteral catheterization. Tract dilation was accomplished using Amplatz dilators of ≤24F or 28F. PCNL was accomplished using a rigid nephroscope with ultrasound and/or pneumatic lithotriptor with the patient under general anesthesia. RESULTS Of the 5 patients, 2 were men and 3 were women, and the mean age was 36.8 years (range 32-44), and the mean stone burden was 475 mm2 (range 400-1350). The mean operative and fluoroscopic screening time was 62.2 minutes (range 50-90) and 3.1 minutes (range 2-5), respectively. Of the 5 patients, 3 were stone free after PCNL. Auxiliary procedures were required in 2 patients and included second-look PCNL in 1 and ureteroscopy in 1. Thus, all 5 patients were rendered completely stone free after the final procedure. No severe complications, either from anesthesia or the surgical procedure, were observed in the patients. Two of the patients had to stay for 24 hours to screen for pulmonary and cardiac signs in the intensive care unit after PCNL. CONCLUSIONS Larger stones or shock wave lithotripsy-refractory stones can be managed safely and effectively with PCNL in patients with scoliosis when they have been appropriately assessed before PCNL.
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Affiliation(s)
- Cengiz Kara
- Department of Urology, Ministry of Health, Kecioren Training and Research Hospital, Ankara, Turkey.
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Singh O, Gupta SS, Singh J, Hasan SU. Giant renal calculus in a horseshoe kidney presenting as an abdominal lump. ACTA ACUST UNITED AC 2011; 39:503-7. [PMID: 21249492 DOI: 10.1007/s00240-010-0361-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 12/30/2010] [Indexed: 11/25/2022]
Abstract
We report a case of giant renal calculus of 14 × 10.5 × 9 cm in size and weighing 790 g, in a horseshoe kidney, along with two large calculi on the opposite side. Patient presented with unusual complaint of an abdominal lump only. Physical examination revealed a stony hard mass on the left side of the abdomen, extending from the subcostal region to just above the iliac crest. A giant renal calculus on the left and two large calculi on the right side of a horseshoe kidney were diagnosed on computed tomography (CT) scan. Percutaneous nephrolithotomy, followed after 5 days by open pyelolithotomy was done for the stones on the right and left side, respectively. Analysis revealed a calcium phosphate stone. This case is worth reporting as it was not only the 8th heaviest renal stone reported in the English literature, but also the first giant stone to be reported in a horseshoe kidney.
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Affiliation(s)
- Onkar Singh
- Department of Urology, Bhopal Memorial Hospital and Research Centre, Bhopal 462038, India.
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Borin JF. Editorial comment. Urology 2010; 76:1337-8; author reply 1338. [PMID: 21130249 DOI: 10.1016/j.urology.2010.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 04/05/2010] [Accepted: 04/05/2010] [Indexed: 11/28/2022]
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Ozden E, Bilen CY, Mercimek MN, Tan B, Sarıkaya S, Sahin A. Horseshoe Kidney: Does It Really Have Any Negative Impact on Surgical Outcomes of Percutaneous Nephrolithotomy? Urology 2010; 75:1049-52. [DOI: 10.1016/j.urology.2009.08.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Revised: 07/15/2009] [Accepted: 08/14/2009] [Indexed: 10/20/2022]
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Liatsikos EN, Kallidonis P, Stolzenburg JU, Ost M, Keeley F, Traxer O, Bernardo N, Perimenis P, Smith AD. Percutaneous Management of Staghorn Calculi in Horseshoe Kidneys: A Multi-Institutional Experience. J Endourol 2010; 24:531-536. [DOI: 10.1089/end.2009.0264] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Micheal Ost
- Department of Urology, Albert Einstein College of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Frank Keeley
- Department of Urology, Spire Bristol Hospital, Bristol, United Kingdom
| | | | - Norberto Bernardo
- Department of Urology, University of Buenos Aires, Buenos Aires, Argentina
| | - Petros Perimenis
- Department of Urology, University of Patras, School of Medicine, Patras, Greece
| | - Arthur D. Smith
- Department of Urology, Albert Einstein College of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
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