TY - JOUR
T1 - The presence of horseshoe kidney does not affect the outcome of percutaneous nephrolithotomy
AU - Miller, Nicole L.
AU - Matlaga, Brian R.
AU - Handa, Shelly E.
AU - Munch, Larry C.
AU - Lingeman, James E.
PY - 2008/6/1
Y1 - 2008/6/1
N2 - Background and Purpose: Large or complex calculi within a horseshoe kidney can present a challenge because many cases are associated with other aberrant anatomy. We performed a study to define the outcome of patients with a horseshoe kidney who were treated with percutaneous nephrolithotomy (PNL). Patients and Methods: From August 1999 to February 2007, 44 PNLs were performed in 35 patients for calculi within a horseshoe kidney. Mean age was 55.4 years. Parameters evaluated to assess the outcomes of PNL included presenting symptoms, stone burden, location of access, stone-free rate, need for secondary intervention, length of stay (LOS), complication rate, stone analysis, and metabolic data. Results: The average stone burden per kidney was 2.59 cm (range 1-6.2 cm). Single percutaneous access was used in 97.7%. Location of the access tract was upper pole (82.2%), interpolar (13.4%), and lower pole (4.4 %). Flexible nephroscopy was performed in all patients. The stone-free rate after primary PNL was 84.1%. Second-look nephroscopy was performed in five kidneys. Overall stone-free rate was 93.2%. Average LOS was 1.92 days (range 1-4 d). Overall complication rate was 14.3%. Stone analysis revealed predominantly calcium stones, and metabolic abnormalities were demonstrated in all patients with 24-hour urine studies. Conclusions: PNL is the treatment of choice for large and/or complex stones. The presence of a horseshoe kidney does not affect the outcome of PNL. Upper pole access is usually preferred, and flexible nephroscopy is essential to maximize stone-free rates. SA and metabolic data support the premise that calculus formation is a metabolic event.
AB - Background and Purpose: Large or complex calculi within a horseshoe kidney can present a challenge because many cases are associated with other aberrant anatomy. We performed a study to define the outcome of patients with a horseshoe kidney who were treated with percutaneous nephrolithotomy (PNL). Patients and Methods: From August 1999 to February 2007, 44 PNLs were performed in 35 patients for calculi within a horseshoe kidney. Mean age was 55.4 years. Parameters evaluated to assess the outcomes of PNL included presenting symptoms, stone burden, location of access, stone-free rate, need for secondary intervention, length of stay (LOS), complication rate, stone analysis, and metabolic data. Results: The average stone burden per kidney was 2.59 cm (range 1-6.2 cm). Single percutaneous access was used in 97.7%. Location of the access tract was upper pole (82.2%), interpolar (13.4%), and lower pole (4.4 %). Flexible nephroscopy was performed in all patients. The stone-free rate after primary PNL was 84.1%. Second-look nephroscopy was performed in five kidneys. Overall stone-free rate was 93.2%. Average LOS was 1.92 days (range 1-4 d). Overall complication rate was 14.3%. Stone analysis revealed predominantly calcium stones, and metabolic abnormalities were demonstrated in all patients with 24-hour urine studies. Conclusions: PNL is the treatment of choice for large and/or complex stones. The presence of a horseshoe kidney does not affect the outcome of PNL. Upper pole access is usually preferred, and flexible nephroscopy is essential to maximize stone-free rates. SA and metabolic data support the premise that calculus formation is a metabolic event.
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U2 - 10.1089/end.2008.0051
DO - 10.1089/end.2008.0051
M3 - Article
C2 - 18484885
AN - SCOPUS:46249096541
SN - 0892-7790
VL - 22
SP - 1219
EP - 1225
JO - Journal of Endourology
JF - Journal of Endourology
IS - 6
ER -