Percutaneous Nephrolithotomy in Abnormal Kidneys: Single-Center Experience
Received 12 June 2008; accepted 24 October 2008. published online 04 February 2009.
Refers to article:
Editorial Comment
Tina K. Schuster, Timothy D. Averch
Urology
April 2009 (Vol. 73, Issue 4, Page 714) Full Text |
Full-Text PDF (87 KB)
Reply
N.P. Gupta, Saurabh Mishra, Ajay Anand, Amlesh Seth
Urology
April 2009 (Vol. 73, Issue 4, Pages 714-715) Full Text |
Full-Text PDF (92 KB)
Objectives
To evaluate the outcome of percutaneous nephrolithotomy (PCNL) in anomalous kidneys performed at our center.
Methods
A total of 46 patients (52 renal units) with renal abnormalities were offered PCNL from January 2000 to December 2007 at our department. Of these 46 patients, 35 had a fusion anomaly (31 with a horseshoe kidney and 4 with crossed fused ectopia), 7 had malrotation, and 4 had ectopic pelvic kidneys. All 4 patients with a pelvic ectopic kidney underwent laparoscopic-assisted PCNL. The mean age was 31.5 years (range 16-52). The male/female ratio was 1.55, the left-to-right ratio was 1.3, and 6 patients had bilateral renal stones (all in horseshoe kidneys). The mean stone size was 2.4 cm (range 1-5). In addition, 8 patients (5 with a horseshoe kidney, 2 with an ectopic pelvic kidney, and 1 with a malrotated kidney) had a history of failed extracorporeal shock wave lithotripsy.
Results
Complete clearance was achieved in all renal units (45 at the first attempt and 7 with a “relook”). The stone was cleared by a single tract in 46 renal units (88.5%), and 6 required 2 tracts (3 horseshoe kidneys, 2 malrotated kidneys, and 1 crossed fused ectopic kidney). Five patients with a horseshoe kidney underwent tubeless PCNL. The mean operating time for PCNL was 82.5 minutes (range 30-150), and the mean hospital stay was 3.2 days (range 1-8). The average decrease in hemoglobin was 1.4 g/dL (range 0.5-4). One patient developed injury to the pleura that was managed by intercostal tube drainage. Two patients developed post-PCNL sepsis.
Conclusions
Although PCNL in anomalous kidneys is technically demanding, it gives excellent results for large or extracorporeal shock wave lithotripsy-refractory stones, if performed carefully.
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Reprint requests: N. P. Gupta, M.D., Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029 India
ABSTRACT