Percutaneous nephrolithotomy (PCNL) in kidneys with fusion and rotation anomalies

Abstract

Objectives: Fusion and rotation anomalies are among the most common anomalies of the kidneys especially the horseshoe kidneys that have abnormal mixtures of malrotation, ectopia and fusion. Percutaneous nephrolithotomy (PCNL) in horseshoe kidney and malrotation kidney is challenging. We report PCNL in 10 horseshoe kidneys and 4 kidneys with congenital malrotation. Material and Method: PCNL was done in 14 kidneys of 12 patients who had horseshoe kidneys (6 patients) and malrotation kidneys (4 patients). Two patients with horseshoe kidney had bilateral calculi. One patient had simultaneous PCNL. Upper pole access was done in 12 kidneys under fluoroscopic guidance with modified PCNL technique. Tubeless PCNL was done in 7 kidneys. Results: Stone-free rate was 86% and the fragment of stones less than 4 mm was 14%. Only minimal pleural effusion was found in one patient that no intervention was needed. Average hospital stay was 3.3 days. Conclusion: Percutaneous nephrolithotomy (PCNL) in horseshoe kidney and malrotation kidney is effective and a safe method in wish only a minor modified technique is needed. Upper pole access was used in most of the cases. No increasing of the complications of PCNL in horseshoe kidneys and malrotion kidneys is found comparing to the same procedure done in the normal kidney.