Comparison between Different Techniques for Management of Renal Stones in Horseshoe Kidneys

Abstract

Thanks to the development in laparoscopic techniques, and instruments, and increasingly accumulating experiences of the surgeons in laparoscopic surgery, this minimally invasive approach has become a realistic alternative in the management of stone disease in anomalous kidneys. Flexible ureteroscopy in horseshoe kidneys has been reported in a few patients to date. Andreoni et al., reported the use of an access sheath to aid flexible ureteroscopy in a horseshoe kidney. We consider flexible ureteroscopy to be a valuable treatment option in horseshoe kidneys with smaller stone burdens allowing the fragmentation and removal of stones which might not otherwise pass freely from the aberrant drainage system. Our experience shows that PCNL and laparoscopic pyelolithotomy are safe and effective treatment for stones in horseshoe kidneys, providing very good stone-clearance rates 88.1% and 88.9% respectively. This study also shows that for smaller stone burdens, flexible ureteroscopy is valid treatment option with acceptable stone clearance rates. However, appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also stone location and the presence of further anomalies such as malrotation. Thus, in some circumstances alternatives to PCNL and laparoscopic pyelolithotomy, ESWL and flexible ureteroscopy must be considered.