[Hydronephrosis in a horseshoe kidney].

The authors studied hydronephrosis characteristics for horseshoe kidney in 170 patients aged 15-70. Basing on anatomic and functional features and urethral condition in each patient 136 operative interventions on one or two parts of the fused kidney in 125 patients were conducted. 26 heminephrectomies were carried out in hydronephrosis stage III, pyonephrosis and acute purulent focal pyelonephritis. 110 stage I-II hydronephrosis patients underwent an original reconstructive combined surgery on the fused kidney ending in formation of two separate organs. High incidence of hydronephrosis in horseshoe kidney against that in normal kidney (64 and 7%, respectively) and not infrequent bilateral involvement (63%) can be explained by anomalous structure of the organ conducive to obstruction of the urinary tracts. In 136 surgical cases the obstruction was due to: peripelvic compression of the ureter above the isthmus of the kidney (128 cases), high branching of the ureter from the renal pelvis with formation of the "spur" (114 cases), periurethritis and the fixed peripelvic ureteral kink by the adhesions (64 cases), congenital stricture of the peripelvic ureter (42 cases) or its compression by the accessory vessel (12 cases). To correct these abnormalities, it is reasonable to employ reconstructive surgery proposed by E. M. Shimkus. The procedure implies the isthmus resection with renal segment part, resection of the lower calyx, pelvic plasty according to Anderson-Hines technique, pyelolithotomy and nephropexy. This surgery abolishes all the underlying causes of fused kidney hydronephrosis and reestablishes urodynamics. It secured positive results by 2-28-year follow-up in 95% of the patients and is recommended as a method of choice.