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Percutaneous Management of Calculi Within Horseshoe Kidneys

2003; Lippincott Williams & Wilkins; Volume: 170; Issue: 1 Linguagem: Inglês

10.1097/01.ju.0000067620.60404.2d

1527-3792

Ganesh V. Raj, Brian K. Auge, Alon Z. Weizer, John D. Denstedt, James Watterson, Darren Beiko, Dean G. Assimos, Glenn M. Preminger,

Dialysis and Renal Disease Management

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jul 2003Percutaneous Management of Calculi Within Horseshoe Kidneys GANESH V. RAJ, BRIAN K. AUGE, ALON Z. WEIZER, JOHN D. DENSTEDT, JAMES D. WATTERSON, DARREN T. BEIKO, DEAN G. ASSIMOS, and GLENN M. PREMINGER GANESH V. RAJGANESH V. RAJ , BRIAN K. AUGEBRIAN K. AUGE , ALON Z. WEIZERALON Z. WEIZER , JOHN D. DENSTEDTJOHN D. DENSTEDT , JAMES D. WATTERSONJAMES D. WATTERSON , DARREN T. BEIKODARREN T. BEIKO , DEAN G. ASSIMOSDEAN G. ASSIMOS , and GLENN M. PREMINGERGLENN M. PREMINGER View All Author Informationhttps://doi.org/10.1097/01.ju.0000067620.60404.2dAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Percutaneous treatment of patients with calculi in a horseshoe kidney can be challenging due to the altered anatomical relationship in the retroperitoneum. Therefore, we performed a multi-institutional review to assess the safety and efficacy of this minimally invasive technique. Materials and Methods: Of 37 patients identified with calculi in a horseshoe kidney at 3 institutions 24 (65%) underwent percutaneous nephrolithotripsy as primary treatment. Average patient age was 48.4 years and 75% of the patients were male. In 3 patients with staghorn calculi mean stone size as measured by computed digitized stone surface area was 448 mm2. Mean followup was 5.8 months. The stone-free rate, complication rate, need for secondary intervention and stone composition were evaluated. Results: Renal access was obtained through an upper pole calix in 63% of the cases, a lower calix in 25% and a middle calix in 4%. Access location was not documented in 1 patient (4%). Of the 24 patients 21 (87.5%) were rendered stone-free after primary or second look procedures. Flexible nephroscopy was used in 84% of cases. Minor complications occurred in 4 patients (16.7%), whereas 3 (12.5%) experienced major complications, including significant bleeding necessitating early cessation, nephropleural fistula and pneumothorax. No deaths occurred as a result of this treatment choice. Stone analysis was available for 21 cases (87.5%). Calcium stones predominated (87.5%), followed by uric acid (9.5%) and struvite (4.8%). Conclusions: Percutaneous treatment of patients with renal calculi in a horseshoe kidney is technically challenging, usually requiring upper pole access and flexible nephroscopy due to the altered anatomical relationships of the fused renal units. The success rate based on stone-free results and a relatively low incidence of major complications suggest that this minimally invasive management option is an effective means of stone management in this complex patient population. References 1 : Horseshoe kidney and urolithiasis. J Urol1981; 125: 620. 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Link, Google Scholar From the Division of Urology, Duke University Medical Center (GVR, BKA, AZW, GMP), Durham, North Carolina, Department of Urology, University of Western Ontario (JDD, JDW, DTB), London, Ontario, Canada, and Department of Urology, Wake Forest University School of Medicine (DGA), Winston-Salem, North Carolina© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited bySkolarikos A, Binbay M, Bisas A, Sari E, Bourdoumis A, Tefekli A, Muslumanoglu A and Deliveliotis C (2018) Percutaneous Nephrolithotomy in Horseshoe Kidneys: Factors Affecting Stone-Free RateJournal of Urology, VOL. 186, NO. 5, (1894-1898), Online publication date: 1-Nov-2011. Volume 170Issue 1July 2003Page: 48-51 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsabnormalitieskidney calculilithotripsykidneyintraoperative complicationsMetricsAuthor Information GANESH V. RAJ More articles by this author BRIAN K. AUGE More articles by this author ALON Z. WEIZER More articles by this author JOHN D. DENSTEDT Financial interest and/or other relationship with Biospecifics, Cook Urological and Lumenis. More articles by this author JAMES D. WATTERSON More articles by this author DARREN T. BEIKO More articles by this author DEAN G. ASSIMOS Financial interest and/or other relationship with Boston Scientific, Ethicon, Ixion Corp. and Olympus. More articles by this author GLENN M. PREMINGER Financial interest and/or other relationship with Microvasive and Mission Pharmacal. More articles by this author Expand All Advertisement PDF downloadLoading ...