Abstract
Objectives
To review our experience with ureteroscopy in treating patients with renal calculi
in anomalous kidneys and to evaluate the efficacy of this approach.
Methods
Eight patients with renal calculi in anomalous kidneys who were managed by ureteroscopic
procedures were identified. Demographic information, preoperative stone burden, operative
information (ureteroscope size, lithotrite used, instruments used, duration of surgery,
complications, stenting), follow-up imaging, and complications were obtained from
the medical record. This information was analyzed to determine the most frequently
used instruments and stone-free rates.
Results
Our cohort consisted of 4 patients with horseshoe kidneys (HSK) and 4 patients with
pelvic kidneys (PK) (6 male, 2 female, mean age, 50.6 years). The average preoperative
stone burden of the 11 treated calculi was 1.4 cm, with 5 stones located in the renal
pelvis, 2 in the upper pole, and 4 in lower pole calyces. A 7.5F flexible ureteroscope,
holmium laser lithotripsy, and nitinol baskets and graspers were used in all patients.
Six patients had complete clearance of the stone on postoperative imaging (75% HSK,
75% PK), with 88% of patients asymptomatic after their procedure. No patients required
additional surgical intervention.
Conclusions
Flexible ureteroscopy with holmium laser lithotripsy and the use of nitinol baskets
and graspers provides a reasonable alternative to shock wave lithotripsy in the management
of patients harboring renal calculi in anomalous kidneys. In addition, ureteroscopy
can be considered a primary option for managing select patients with symptomatic stones
in PKs before a percutaneous surgical approach.
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Article info
Publication history
Accepted:
September 2,
2004
Received:
February 13,
2004
Footnotes
G. M. Preminger is a paid consultant to Olympus America and Boston Scientific.
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
