Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Curr Opin Urol. 2011 Mar;21(2):145-53. doi: 10.1097/MOU.0b013e3283435c79.
The treatment options in urolithiasis in kidneys with abnormalities of form and location can be challenging due to abnormal anatomy (calyceal and renal orientation), relative immobility interfering with movement of equipment, and abnormal relation with other visceral organs.
In this review, we focus on the different techniques and results of various treatment modalities. The approach to managing these stones should be individualized. We also allude to the results of a few recent series and emphasize various treatment options.
Ultrasound helps in gaining access in ectopic kidneys, in addition to being a diagnostic tool. Computerized tomography is pivotal in helping to decide the management and choosing the method of treatment in anomalous kidneys. Flexible ureteroscopy can be a useful tool in stones less than 2 cm in size with the availability of smaller flexible ureteroscopes and access sheaths. However the surgeon should consider complete 'on table' clearance in these patients as the drainage is likely to be impaired. Ultrasound guided percutaneous approaches for ectopic kidneys should be performed by surgeons well versed with it. Laparoscopic assisted percutaneous nephrolithotomy has shown good clearance rates with minimal morbidity and less likelihood of ancillary procedures. Although adequate fragmentation can be achieved with extracorporeal shock wave lithotripsy, the drainage of fragments might be impaired due to the anatomical abnormalities. The choice of shock wave lithotripsy as a treatment option should be made prudently.
由于解剖异常（肾盏和肾盂方向）、设备活动相对受限以及与其他内脏器官的异常关系，异常形态和位置的肾结石的治疗选择具有挑战性。
在这篇综述中，我们重点介绍了各种治疗方式的不同技术和结果。对这些结石的处理方法应个体化。我们还提到了一些最近的系列结果，并强调了各种治疗选择。
超声有助于进入异位肾，此外还可作为诊断工具。计算机断层扫描对于帮助决定管理和选择异常肾脏的治疗方法至关重要。在有较小的柔性输尿管镜和进入鞘的情况下，软性输尿管镜检查可用于治疗大小小于 2 厘米的结石。然而，由于引流可能受损，外科医生应考虑在这些患者中进行完全“台上”清除。超声引导经皮入路治疗异位肾应由熟练掌握该技术的外科医生进行。腹腔镜辅助经皮肾镜碎石术具有良好的清除率，发病率低，辅助手术的可能性小。尽管体外冲击波碎石术可以达到充分的碎石效果，但由于解剖异常，碎片的引流可能会受到影响。应谨慎选择体外冲击波碎石术作为治疗选择。
