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Percutaneous management of calculi within horseshoe kidneys.

Publication ,  Journal Article
Raj, GV; Auge, BK; Weizer, AZ; Denstedt, JD; Watterson, JD; Beiko, DT; Assimos, DG; Preminger, GM
Published in: J Urol
July 2003

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.

Duke Scholars

Published In

J Urol

DOI

ISSN

0022-5347

Publication Date

July 2003

Volume

170

Issue

1

Start / End Page

48 / 51

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Retrospective Studies
  • Middle Aged
  • Male
  • Lithotripsy
  • Kidney Calculi
  • Kidney
  • Humans
  • Female
  • Aged
 

Citation

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Raj, G. V., Auge, B. K., Weizer, A. Z., Denstedt, J. D., Watterson, J. D., Beiko, D. T., … Preminger, G. M. (2003). Percutaneous management of calculi within horseshoe kidneys. J Urol, 170(1), 48–51. https://doi.org/10.1097/01.ju.0000067620.60404.2d
Raj, Ganesh V., Brian K. Auge, Alon Z. Weizer, John D. Denstedt, James D. Watterson, Darren T. Beiko, Dean G. Assimos, and Glenn M. Preminger. “Percutaneous management of calculi within horseshoe kidneys.J Urol 170, no. 1 (July 2003): 48–51. https://doi.org/10.1097/01.ju.0000067620.60404.2d.
Raj GV, Auge BK, Weizer AZ, Denstedt JD, Watterson JD, Beiko DT, et al. Percutaneous management of calculi within horseshoe kidneys. J Urol. 2003 Jul;170(1):48–51.
Raj, Ganesh V., et al. “Percutaneous management of calculi within horseshoe kidneys.J Urol, vol. 170, no. 1, July 2003, pp. 48–51. Pubmed, doi:10.1097/01.ju.0000067620.60404.2d.
Raj GV, Auge BK, Weizer AZ, Denstedt JD, Watterson JD, Beiko DT, Assimos DG, Preminger GM. Percutaneous management of calculi within horseshoe kidneys. J Urol. 2003 Jul;170(1):48–51.
Journal cover image

Published In

J Urol

DOI

ISSN

0022-5347

Publication Date

July 2003

Volume

170

Issue

1

Start / End Page

48 / 51

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Retrospective Studies
  • Middle Aged
  • Male
  • Lithotripsy
  • Kidney Calculi
  • Kidney
  • Humans
  • Female
  • Aged