Percutaneous nephrolithotomy (PCNL) in horse shoe kidneys.

Objective: To review our experience of PCNL in horse shoe kidneys.

Methods: Between June 2001 and January 2005 we performed PCNL in 16 Horse shoe kidneys in 14 patients with calculi, 2 patients had bilateral calculi. Percutaneous puncture was made with patient in prone position. Their ages ranged between 4 to 52 years with a mean age of 26.3 years. Our mean stone burden was 820 mm2 (range 40-1370 mm2). PCNL access tract was made in upper pole of the kidney in 13 (80%) while 3 (20%) had mid-pole access.

Results: Stone clearance after primary PCNL was achieved in 12 kidneys. Of the remaining 4 kidneys, 2 underwent re-look PCNL via the same tract and one more kidney was rendered stone free, while the other had an insignificant residue of 3mm. Hence we achieved a stone clearance rate of 81% after primary and secondary PCNL. Further 2 kidneys underwent single session ESWL for residual stones and became stone free improving our complete stone clearance rate after auxiliary procedure to 93.7%. Mean hospital stay for these patients was 3.8 days (range 3-10 days). Follow up available for these HSK patients with PCNL was 11 to 49 months with a mean follow up of 29.1 months. Complications were seen in 3 (21%) patients who developed transient post operative pyrexia and 1 (7%) patient presented on the 18th post operative day with a stone fragment in ureter and leakage from PCNL site. He was managed by ureteric catheterization for 48 hours when he passed the fragment spontaneously and became dry. None of our patients developed post PCNL bleeding or wound infection.

Conclusion: PCNL in horse shoe kidneys is no more difficult than normal kidneys and does not carry a greater risk than reported for normal kidneys. This effective modality resulted in almost 93% stone clearance with minimal complications.