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    Kidneys

    Horseshoe kidney is a common malformation in which the two kidneys are connected by a piece of tissue, which also causes them to be abnormally positioned. When patients with horseshoe kidney develop stones, treatment can be more difficult than in those with normal, separated kidneys.

    Extracorporeal shock wave lithotripsy (ESWL) uses shock waves to break up urinary stones and is effective in patients whose stones are not too large or too numerous. A recent study suggests that patients with large or extensive stones can be treated with another technique. Percutaneous nephrolithotomy involves removing stones through an incision in the skin after their location has been verified through x-rays or CT scan. Canadian researchers from the University of Manitoba in Winnipeg used this technique successfully on 12 patients with horseshoe kidney, which included nine men, aged 17 to 66, and three women, aged 39 to 88.

    Eight patients had stones in the lower kidney ducts, near where the kidneys were connected, and half of the patients had loops of bowel behind the kidneys that made surgery more difficult. Because of the unusual structure of horseshoe kidney, the doctors had to use a flexible nephroscope to get to the stones and move them to an area where the rigid nephroscope could be used to remove them. The surgery took an average of 170 minutes, but ranged from 67 to 298 minutes.

    Three patients needed a "second look procedure," meaning that the doctors had go back to finish removing the stones after checking the post-operative x-rays. Residual stones in one of these patients were broken up with ESWL; the other two left the hospital with clusters of small stones.

    None of the patients developed infection or required blood transfusion, and only one patient had urine leakage from the surgery site for more than 48 hours. Over an average follow-up period of 21 months (range two to 64), two patients developed new stones that were successfully treated.

    The researchers concluded, in a recent issue of "The Journal of Urology," that with careful imaging before surgery and the use of a flexible nephroscope, percutaneous nephrolithotomy is "a safe and effective technique for the removal of [stones] from horseshoe kidneys."



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