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Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study

2020; Mary Ann Liebert, Inc.; Volume: 35; Issue: 7 Linguagem: Inglês

10.1089/end.2020.0128

1557-900X

Fábio C. Vicentini, Eduardo Mazzucchi, Mehmet İlker Gökçe, Mario Sofer, Yılören Tanıdır, Tarık Emre Şener, Petrônio Augusto de Souza Melo, Brian H. Eisner, Timothy Batter, Thomas Chi, Manuel Armas‐Phan, Cesare Marco Scoffone, Cecilia Maria Cracco, Braulio Omar Manzo Pérez, Oriol Angerri, Esteban Emiliani, Orazio Maugeri, Karen Stern, Carlos Batagello, Manoj Monga,

Urinary Bladder and Prostate Research

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.