Department of Urology, Cairo University hospitals, 1 Al-saray street, Al-Manial, Cairo 11559, Egypt.
BMC Urol. 2009 Nov 16;9:17. doi: 10.1186/1471-2490-9-17.
this study represents a case series to evaluate how successful is the rigid percutaneous nephroscopy as a tool for clearance of all stones in various locations in horseshoe kidneys.
Between 2005 and 2009, we carried out PCNL (percutaneous nephrolithotomy) for calculi in horseshoe kidneys in 21 renal units (17 patients) in our department. The indications were large stone burden in 18 units and failed SWL(shock wave lithotripsy) in 3 renal units. All procedures were done under general anesthesia; using fluoroscopic guidance for localization and standard alkan dilatation followed by rigid nephroscopy and stone extraction with or without stone disintegration. We analyzed our results regarding the site and number of the required access, the intra and postoperative complications, the presence of any residual stones, as well as their location.
The procedure was completed, using a single access tract in 20 renal units, with the site of puncture being the upper calyx in nine units and the posterior middle calyx in eleven units. Only in one renal unit, two access tracts (an upper and a lower calyceal) were required for completion and a supracostal puncture was required in another case. There was no significant intraoperative bleeding and no blood transfusion was required in any patient. A pelvic perforation occurred in one case, requiring longer PCN (percutaneous nephrostomy) drainage. One patient with infection stones suffered urosepsis postoperatively which was successfully managed. Three cases had residual stones, all located in the renal isthmus, all residuals were un approachable with the rigid instrument; resulting in a overall stone-free rate of 85.7% at discharge.
Percutaneous nephrolithotomy is generally safe and successful in the management of stones in horseshoe kidneys. However, location of the stones in these patients is crucial to decide the proper tool for optimal stone clearance result.
本研究是一项病例系列研究，旨在评估经皮肾镜取石术（PCNL）作为清除马蹄肾中各种部位结石的工具的成功率。
在我们科室，2005 年至 2009 年间对 17 名患者的 21 个肾脏单位（肾单位）的马蹄肾结石患者进行了 PCNL。18 个肾单位的结石负荷较大，3 个肾单位的 SWL（体外冲击波碎石术）失败，是手术的适应证。所有手术均在全身麻醉下进行；使用荧光透视引导定位和标准的 Alkan 扩张，然后进行硬性肾镜取石和结石提取，同时或不进行结石粉碎。我们分析了手术的结果，包括所需的通道部位和数量、围手术期并发症、是否有残留结石及其位置。
20 个肾单位采用单一通道完成了手术，9 个肾单位的穿刺部位在上盏，11 个肾单位的穿刺部位在后中盏。只有在一个肾单位中，需要两个通道（上盏和下盏）才能完成手术，另一个肾单位需要经肋上穿刺。术中无明显出血，无患者需要输血。一例发生肾盂穿孔，需要延长 PCN（经皮肾造口术）引流。一例感染性结石患者术后发生尿脓毒症，经成功治疗。3 例患者有残留结石，均位于肾峡部，均无法用硬性器械触及；出院时总的结石清除率为 85.7%。
PCNL 治疗马蹄肾结石一般安全有效。然而，这些患者结石的位置对于决定适当的工具以获得最佳的结石清除效果至关重要。
