R.I. Payuk

Peculiarities of the percutaneous nephrolithotripsy for the treatment of problematic nephrolithiasis of the horseshoe kidney

Performance of PNL in case of the horseshoe kidney is more complicated in comparison with the normal kidney. Steps of the PNL in case of staghorn and large-volume nephrolithiasis: 1) cystoscopy and placement of the ureteral catheter; 2) puncture of the renal collecting system; 3) channel dilatation; 4) nephroscopy, lithotripsy and fragments evacuation; 5) placement of the nephrostomy tube and ureteral catheter withdrawal. During the PNL on the horseshoe kidney the hazard of bleeding is not higher than in the normal kidney because the renal vessels are located aside from the nephrostomy channel. We have performed 24 lithotripsy operations in 22 patients with staghorn, large-volume and multiple stones of the horseshoe kidney. The modern methods of treatment of the renal stones are applicable in case of anomalous renal anatomy too, including the horseshoe kidney. Performing the PNL for treatment of problematic nephrolithiasis in the horseshoe kidney is more complicated than in the kidney with normal anatomy. In case of the ineffective PNL, thick kidney isthmus, ureteral stricture the open surgery is the treatment of choice. Complete clearance of kidney from the stone was achieved in 21 (95.45%) patients after the primary and secondary PNL and ESWL.