Urolithiasis

, Volume 45, Issue 4, pp 407–414 | Cite as

Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study

  • Sanjay Khadgi
  • Babu Shrestha
  • Hamdy Ibrahim
  • Sunil Shrestha
  • Mohammed S. ElSheemy
  • Ahmed M. Al-Kandari
Original Paper
First Online:
Received:
Accepted:

Abstract

To evaluate safety and efficacy of minipercutaneous nephrolithotomy (Mini-PNL) in management of stones in different types of renal anomalies. Patients with stones ≥2 cm or SWL-resistant stones in anomalous-kidneys treated by Mini-PNL between March 2010 and September 2012 were included prospectively. Mini-PNL was done under regional anesthesia in prone position with fluoroscopic guidance through 18 Fr sheath using semirigid ureteroscope (8.5/11.5 Fr) and pneumatic lithotripter. All patients were followed-up for 2–3 years. Stone-free rate was defined as absence of residual fragments ≥2 mm. Student-T, Mann–Whitney, Chi square (χ 2), Fisher-exact, one way ANOVA or Kruskal–Wallis test were used for analysis. Mini-PNL was performed for 59 patients (20 horseshoe, 15 malrotated, 7 polycystic, 13 duplex and 4 ectopic pelvic-kidneys). Mean age was 40.18 ± 12.75 (14–78) years. Mean stone burden was 31.72 ± 21.43 (7.85–141.3) mm2. Two tracts were required in 7 (11.9 %) patients. Tubeless Mini-PNL with double-J insertion was performed in all patients except two. Operative time was 50.17 ± 18.73 (15–105) min. Hemoglobin loss was 0.44 ± 0.30 (0–1.4) g/dL. Complications were reported in 15 (25.4 %) patients. No pleural injury, sepsis, perinephric-collection or renal-pelvis perforation were reported. Stone-free rate was 89.8 % (converted to open-surgery in one patient, second-look PNL in two patients, auxiliary SWL in three patients). Stone-free rate improved to 98.3 % after retreatment and auxiliary SWL. Site of puncture was mostly upper calyceal in horseshoe-kidney (80 %), mid calyceal in polycystic-kidney (85.7 %) and lower calyceal in duplex-kidney (46.2 %). Punctures were also significantly infracostal in horseshoe-kidney (100 %) and supracostal in both duplex (53.8 %) and malrotated-kidneys (66.7 %). Mini-PNL is safe for management of stones in anomalous-kidney with SFR comparable to standard-PNL but with less complications.

Keywords

Mini-percutaneous nephrolithotomy Renal stones Anomalous kidney Horseshoe kidney Polycystic kidney 

Abbreviations

DJ

Double-J stent

IVP

Intravenous pyelography

KUB

Plain abdominal radiography

Mini-PNL

Mini-percutaneous nephrolithotripsy

NCCT

Non-contrast computed tomography scan

PCN

Percutaneous nephrostomy

PNL

Percutaneous nephrolithotripsy

SFR

Stone free rate

SWL

Extracorporeal shockwave lithotripsy

UTI

Urinary tract infection

US

Abdominal ultrasonography

UPJ

Ureteropelvic junction

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Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding source

None.

Ethical approval

The study was in accordance with the ethical standards of the local ethical committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sanjay Khadgi
    • 1
  • Babu Shrestha
    • 2
    • 3
  • Hamdy Ibrahim
    • 4
  • Sunil Shrestha
    • 1
  • Mohammed S. ElSheemy
    • 5
  • Ahmed M. Al-Kandari
    • 6
  1. 1.EndourologistsVayodah and Venus International HospitalsKathmanduNepal
  2. 2.Vayodah and Venus International HospitalsKathmanduNepal
  3. 3.Department of AnaesthesiologyKathmandu Medical CollegeKathmanduNepal
  4. 4.Urology DepartmentFayoum UniversityFayoumEgypt
  5. 5.Urology Department, Kasr Al-Ainy HospitalsCairo UniversityCairoEgypt
  6. 6.Kuwait UniversityKuwaitKuwait

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