OBJECTIVE: Complex calculi in horseshoe kidney
(HK) present a significant management challenge. Here, we report the
clinical efficacy of extracorporeal shock wave lithotripsy (ESWL), minimally
invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy
(FURS), combined with holmium laser lithotripsy, in the treatment of calculi
in HK.
METHODS AND RESULTS: From January 2005 to May 2014, 62 HK patients
with renal calculi were reviewed in terms of medical history, treatment
modality and therapeutic outcome in a single tertiary care
hospital. Among the patients, 11 with a solitary stone ≤ 1.5 cm in
diameter received ESWL, leading to overall stone-free rate of 72.7%; 18
with stone diameter ≤ 2-3 cm received retrograde flexible ureteroscopy,
with a recorded mean digitized surface area (DSA) of 339.6 ± 103.9 mm2, mean operation time of 93.1 ± 11.5 minutes and overall
stone-free rate of 88.9%; and 33 with staghorn or complex calculi (d
≥ 2 cm) had MPCNL or MPCNL-FURS, with a recorded mean DSA of 691.0 ±
329.9 vs. 802.9 ± 333.3 mm2, mean operation time of 106.4 ±
16.6 vs. 124.4 ± 15.1 min and overall stone-free rate of 89.5% vs.
92.9%. For complex calculi (d ≥ 2 cm), MPCNL combined with
antegrade FURS was superior in terms of reducing number of tracts,
controlling mean hemoglobin drop, but required longer operation time,
comparing with MPCNL alone.
CONCLUSIONS: As minimally invasive treatments, a
combination of MPCNL and antegrade FURS provides a safe and effective
modality in the management of staghorn or complex calculi (d ≥ 2 cm) in
HK with significantly reduced blood loss comparing to MPCNL alone, and
retrograde FURS alone is favorable for stones with a diameter ≤ 2-3 cm.
ESWL is effective for viable small solitary stones (d ≤ 1.5 cm).
Treatment modality should be tailored based on individual condition.
