DOI: http://dx.doi.org/10.18203/2349-2902.isj20204967

Percutaneous nephrolithotomy for large renal stones in anomalous kidneys

Syed Javid F. Qadri, Mufti Mahmood Ahmed, Zafar Saleem Khanday, Asim Leharwaal

Abstract


Background: Percutaneous nephrolithotomy (PCNL) is an important surgical method for managing renal stones of any size. Anomalous kidneys pose additional technical challenge to the operating surgeon to perform PCNL in these anatomically abnormal kidneys especially if the stone load is large. The aim of this study is to present the efficacy and limitations of PCNL in managing stones >2 cm in size in anomalous kidneys.

Methods: This was a retrospective single centre study of PCNL in anomalous kidneys with stones >2 cm in size.

Results: 30 patients of kidney stones >2 cm underwent PCNL. Our series of patients included 19 (63.32%) cases of horseshoe kidneys, 9 (30%) malrotated kidneys, 1 (3.34%) pelvic and 1 (3.34%) crossed fused ectopia. We achieved complete stone clearance in 26 (86.67%) patients. Presence of staghorn calculus was the most important statistically significant factor limiting complete clearance.

Conclusion: PCNL is an effective procedure for management of patients with large stones in anomalous kidneys. Appropriate preoperative evaluation especially imaging, appropriate selection of cases and most importantly excellent technical expertise is needed to achieve high stone clearance rates with minimal morbidity.


Keywords


Anomalous kidneys, Horseshoe kidney, PCNL

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References


Grases F, Conte A, March JG, Genestar C, Costa-Bauzá A, Martin M et al. Epidemiology of urinary stone disease in the Balearic Islands Community. Int Urol Nephrol. 1994;26(2):145-50.

Hesse A, Siener R. Current aspects of epidemiology and nutrition in urinary stone disease. World J Urol. 1997;15(3):165-17.

Stein RJ, Desai MM. Management of urolithiasis in the congenitally abnormal kidney (horseshoe and ectopic). Curr Opin Urol. 2007;17(2):125-31.

Gupta NP, Mishra S, Seth A, Anand A. Percutaneous nephrolithotomy in abnormal kidneys: single-center experience. Urolo. 2009;73(4):710-4.

Ganpule AP, Desai MR. Urolithiasis in kidneys with abnormal lie, rotation or form. Curr Opin Urol. 2011;21(2):145-53.

Mosavi-Bahar SH, Amirzargar MA, Rahnavardi M, Moghaddam SM, Babbolhavaeji H, Amirhasani S. Percutaneous nephrolithotomy in patients with kidney malformations. J Endourol. 2007;21(5):520-4.

Osther PJ, Razvi H, Liatsikos E, Averch T, Crisci A, Garcia JL et al. Croes PCNL Study Group. 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(10):1627-32.