Surgical management of urolithiasis in patients with a horseshoe kidney: key technical considerations

Introduction. The combination of urolithiasis with other diseases and/or malformations, especially abnormally developed kidneys and urinary tract, presents a certain complexity for the diagnosis of the underlying disease and its complications, as well as for the initial, repeated and subsequent treatment of patients. One of the abnormalities in the development of the kidneys is the horseshoe shape. It is the most common variant of fusion and, according to domestic and foreign literature, occurs in approximately 0.25% (1:500 – 1:400) of the population.

Objective. To determine the most optimal approach when performing percutaneous nephrolithotripsy on horseshoe kidneys, analyzing intraand postoperative complications, the number and size of residual stones.

Materials & methods. In the period from November 2020 to March 2024, 12 patients — 8 (66.7%) men and 4 (33.3%) women) with horseshoe kidneys were treated. The size of the stones ranged from 2.0 to 2.5 cm (2.26 ± 0.16 cm), the density of the stones averaged 1083.3 ± 54.7 HU (from 1020 to 1200 HU). Surgical treatment of urolithiasis in patients included in the study was carried out using standard percutaneous nephrolithotripsy (PNL) adjusted for renal adhesion and atypical location. All patients underwent spiral CT with intravenous contrast, which made it possible to clarify and assess the size and density of the stone; stereometric location, morphological and functional state of the horseshoe kidney, its skeletotopia, syntopy and holotopia, as well as blood supply.

Results. The technique of access through the upper calyx in the treatment of urolithiasis in patients with horseshoe kidney demonstrates high safety and effectiveness. The absence of bleeding and the relatively low incidence of residual stones indicate the reliability of this approach.

Conclusions. The results of the study confirm a significant superiority of access through the upper calyx in the surgical treatment of urolithiasis in patients with a horseshoe kidney. This method has shown high efficiency and safety minimizing the risk of complications and providing sustainable clinical results.

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