BACKGROUND AND PURPOSE: Large or complex calculi within a horseshoe kidney can present a challenge because many cases are associated with other aberrant anatomy. We performed a study to define the outcome of patients with a horseshoe kidney who were treated with percutaneous nephrolithotomy (PNL). PATIENTS AND METHODS: From August 1999 to February 2007, 44 PNLs were performed in 35 patients for calculi within a horseshoe kidney. Mean age was 55.4 years. Parameters evaluated to assess the outcomes of PNL included presenting symptoms, stone burden, location of access, stone-free rate, need for secondary intervention, length of stay (LOS), complication rate, stone analysis, and metabolic data. RESULTS: The average stone burden per kidney was 2.59 cm (range 1-6.2 cm). Single percutaneous access was used in 97.7%. Location of the access tract was upper pole (82.2%), interpolar (13.4%), and lower pole (4.4 %). Flexible nephroscopy was performed in all patients. The stone-free rate after primary PNL was 84.1%. Second-look nephroscopy was performed in five kidneys. Overall stone-free rate was 93.2%. Average LOS was 1.92 days (range 1-4 d). Overall complication rate was 14.3%. Stone analysis revealed predominantly calcium stones, and metabolic abnormalities were demonstrated in all patients with 24-hour urine studies. CONCLUSIONS: PNL is the treatment of choice for large and/or complex stones. The presence of a horseshoe kidney does not affect the outcome of PNL. Upper pole access is usually preferred, and flexible nephroscopy is essential to maximize stone-free rates. SA and metabolic data support the premise that calculus formation is a metabolic event.
BACKGROUND AND PURPOSE: Large or complex calculi within a horseshoe kidney can present a challenge because many cases are associated with other aberrant anatomy. We performed a study to define the outcome of patients with a horseshoe kidney who were treated with percutaneous nephrolithotomy (PNL). PATIENTS AND METHODS: From August 1999 to February 2007, 44 PNLs were performed in 35 patients for calculi within a horseshoe kidney. Mean age was 55.4 years. Parameters evaluated to assess the outcomes of PNL included presenting symptoms, stone burden, location of access, stone-free rate, need for secondary intervention, length of stay (LOS), complication rate, stone analysis, and metabolic data. RESULTS: The average stone burden per kidney was 2.59 cm (range 1-6.2 cm). Single percutaneous access was used in 97.7%. Location of the access tract was upper pole (82.2%), interpolar (13.4%), and lower pole (4.4 %). Flexible nephroscopy was performed in all patients. The stone-free rate after primary PNL was 84.1%. Second-look nephroscopy was performed in five kidneys. Overall stone-free rate was 93.2%. Average LOS was 1.92 days (range 1-4 d). Overall complication rate was 14.3%. Stone analysis revealed predominantly calcium stones, and metabolic abnormalities were demonstrated in all patients with 24-hour urine studies. CONCLUSIONS: PNL is the treatment of choice for large and/or complex stones. The presence of a horseshoe kidney does not affect the outcome of PNL. Upper pole access is usually preferred, and flexible nephroscopy is essential to maximize stone-free rates. SA and metabolic data support the premise that calculus formation is a metabolic event.
Authors: Ahmet Tefekli; Abdulkadir Tepeler; Tolga Akman; Muzaffer Akçay; Murat Baykal; Mert Ali Karadağ; Ahmet Y Muslumanoglu; Jean de la Rosette Journal: Urol Res Date: 2012-02-04
Authors: Gwen M Grimsby; Sarah P Conley; Terrence L Trentman; Erik P Castle; Paul E Andrews; Laurie A Mihalik; Joseph G Hentz; Mitchell R Humphreys Journal: Mayo Clin Proc Date: 2012-10-08 Impact factor: 7.616