Percutaneous Nephrolithotomy in Horseshoe Kidneys: A Cross-sectional Study

Introduction: Horseshoe Kidneys (HSK) are the most common congenital fusion of the kidneys. After the reports of Wickham and Kellet in 1981 and Clayman in 1983, percutaneous extraction of stones in HSKs has been widely adopted. In this era of advancement of Retrograde Intra Renal Surgery (RIRS), Percutaneous Nephrolithotomy (PCNL) still holds strong position for HSK stone management, due to HSK vascular and pelvicalyceal anatomy. Aim: To evaluate PCNL in managing large HSK stone disease in the form of stone free rate and to assess procedure related complication between October 2016 to March 2020. Materials and Methods: A retrosepective cross-sectional study was conducted between October 2016 to March 2020, in total of 18 patients (21 renal units) underwent PCNL for stone disease in HSK. Stone size >1.5 cm, failed Extra-Corporeal Shockwave Lithotripsy (ESWL) and recurrent stones were included in the study. Results: Mean age of the patients was 40.67±7.87 years, 12 were male and 6 were female. Three patients had stones in both renal units. The mean stone size was 22.19±7.43 (12.00-46.00) mm. Twelve units had stone in the pelvis (57.1%), 6 unit in upper calyx (28.6%). One unit (4.8%) had stone in isthmus and 3 units (14.3%) had staghorn calculi. Access site was upper calyx in majority 76.2% of the cases, 23.8% required additional puncture most commonly through middle calyx. Total 8 patients had postoperative complications, fever being the most common (19%). Complete clearance was obtained in 85.7%, while 14.3% had residual calculi for which ancillary procedures were performed. Conclusion: PCNL can be recommended as the first line of management in the treatment of HSKs with large stone burden, considering its higher clearance rate and minimal complications.