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Role of flexible uretero-renoscopy in management of renal calculi in anomalous kidneys: single-center experience

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Abstract

Introduction

Flexible uretero-renoscopy (FURS) is an accepted modality for management of renal calculi in orthotopically placed kidney. Though it has been used in management of calculi in anomalous kidneys, the literature is scarce.

Aim and objective

To define the role of FURS in the management of stones in anomalous kidneys.

Materials and methods

We performed a retrospective analysis of all the patients with anomalous kidneys who primarily underwent FURS from January 2010 to December 2015 at our institute. In our study, we included patients with anomalies of lie, fusion and rotation. A total of twenty-five patients with twenty-five renal units having renal calculi in anomalous kidneys were evaluated. Indications for FURS included stone size less than or equal to 2 cm, contraindication to PCNL like bleeding tendencies, patients on anticoagulants or patients who refused ESWL and PCNL. Complete clearance of stone was defined as no residual fragment greater than 2 mm at the end of 4 weeks. The parameters evaluated were patient demographics, type of renal anomaly, stone size, location, laterality, patient’s presentation, need for preoperative stenting, operative time, need for postoperative DJ stent, hospital stay, analgesic requirement, number of stages or auxiliary procedures required for stone clearance, success rate and complications.

Results

Twenty-five patients with calculi in anomalous kidneys were managed with FURS. These 25 patients had a total of 37 stones. Out of 25 patients, 14 had ectopic kidneys with 19 stones, 5 had malrotated kidneys with 6 stones, 5 had horseshoe kidneys with 11 stones and one had a left-to-right crossed fused ectopia with a single stone. Average age of presentation was 38.28 ± 12.59 years. Majority of the patients had the stones located in pelvis (n = 11) or lower calyx (n = 11). Eight stones were in middle calyx (n = 8), five in upper calyx (n = 5) and two in upper ureter (n = 2). Fifteen patients had a single stone, and 10 of them had 2 or more stones. Average size of stone was 14.71 ± 4.11 mm and average density being 1210.8 ± 237.7 Hounsfield units. Five patients had a preplaced DJ stent. Average Operative time was 74 ± 21.2 min, and patients had an average hospital stay of 59.48 ± 17.8 h. DJ stent was placed postoperatively in 21 patients, and four were managed with a ureteric catheter. Complete clearance was achieved in 22 (88 %) patients, three patients required two stages and one required the third stage. Three patients (12 %) could not be managed with FURS and required percutaneous stone clearance.

Conclusion

Primary FURS is an effective and less invasive modality for management of renal calculi less than 2 cm in kidneys with anomalies of lie, fusion and rotation. It can offset the low clearance rate and high complication rate of ESWL and PCNL, respectively. Ureteral access sheath is an important tool to overcome anatomical challenges of anomalous kidney. Basket and Laser are indispensable accessories for FURS in anomalous kidneys.

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References

  1. Weizer AZ, Silverstein AD, Auge BK, Delvecchio FC, Raj G, Albala DM, Leder R, Preminger GM (2003) Determining the incidence of horseshoe kidney from radiographic data at a single institution. J Urol 170(5):1722–1726

    Article  PubMed  Google Scholar 

  2. Gross AJ, Fisher M (2006) Management of stones in patients with anomalously sited kidneys. Curr Opin Urol 16(2):100–105

    Article  PubMed  Google Scholar 

  3. Pitts WR Jr, Muecke EC (1975) Horseshoe kidneys: a 40-year experience. J Urol 113(6):743–746

    PubMed  Google Scholar 

  4. Smith JE, Van Arsdalen KN, Hanno PM, Pollack HM (1989) Extracorporeal shock wave lithotripsy treatment of calculi in horseshoe kidneys. J Urol 142(3):683–686

    CAS  PubMed  Google Scholar 

  5. Evans WP, Resnick MI (1981) Horseshoe kidney and urolithiasis. J Urol 125(5):620

    CAS  PubMed  Google Scholar 

  6. Weizer AZ, Springhart WP, Ekeruo WO, Matlaga BR, Tan YH, Assimos DG, Preminger GM (2005) Ureteroscopic management of renal calculi in anomalous kidneys. Urology 65(2):265–269

    Article  PubMed  Google Scholar 

  7. Carr LK, John RA, Jewett MA, Ibanez D, Ryan M, Bombardier C (1996) New stone formation: a comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. J Urol 155(5):1565–1567

    Article  CAS  PubMed  Google Scholar 

  8. Raj GV, Auge BK, Weizer AZ, Denstedt JD, Watterson JD, Beiko DT, Assimos DG, Preminger GM (2003) Percutaneous management of calculi within horseshoe kidneys. J Urol 170(1):48–51

    Article  PubMed  Google Scholar 

  9. Zafar FS, Lingeman JE (1996) Value of laparoscopy in the management of calculi complicating renal malformations. J Endourol 10(4):379–383

    Article  CAS  PubMed  Google Scholar 

  10. Holman E, Tóth C (1998) Laparoscopically assisted percutaneous transperitoneal nephrolithotomy in pelvic dystopic kidneys: experience in 15 successful cases. J Laparoendosc Adv Surg Tech 8(6):431–435

    Article  CAS  Google Scholar 

  11. Molimard B, Al-Qahtani S, Lakmichi A, Sejiny M, de Medina SG, Carpentier X, Traxer O (2010) Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Urology 76(6):1334–1337

    Article  PubMed  Google Scholar 

  12. Honey RJ (1998) Assessment of new tipless nitinol stone basket and comparison with an existing flat-wire basket. J Endourol 12:529–531

    Article  CAS  PubMed  Google Scholar 

  13. Andreoni C, Portis AJ, Clayman RV (2000) Retrograde renal pelvic access sheath to facilitate flexible ureteroscopic lithotripsy for the treatment of urolithiasis in a horseshoe kidney. J Urol 164(4):1290–1291

    Article  CAS  PubMed  Google Scholar 

  14. Lim SH, Jeong BC, Seo SI, Jeon SS, Han DH (2010) Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free. Korean J Urol 51(11):777–782

    Article  PubMed  PubMed Central  Google Scholar 

  15. Atis G, Resorlu B, Gurbuz C, Arikan O, Ozyuvali E, Unsal A, Caskurlu T (2013) Retrograde intrarenal surgery in patients with horseshoe kidneys. Urolithiasis 41(1):79–83

    Article  PubMed  Google Scholar 

  16. Oğuz U, Balci M, Atis G, Bozkurt OF, Tuncel A, Halis F, Aslan Y, Yildirim IO, Senocak C, Yordam M, Atan A (2014) Retrograde intrarenal surgery in patients with isolated anomaly of kidney rotation. Urolithiasis 42(2):141–147

    Article  PubMed  Google Scholar 

  17. Ozden E, Bilen CY, Mercimek MN, Tan B, Sarıkaya S, Sahin A (2010) Horseshoe kidney: does it really have any negative impact on surgical outcomes of percutaneous nephrolithotomy? Urology 75(5):1049–1052

    Article  PubMed  Google Scholar 

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Authors’ contribution

Dr. Singh Abhishek involved in protocol/project development, data analysis and manuscript writing/editing. Dr. Chhabra Jaspreet involved in data analysis and manuscript writing/editing. Dr. Sabnis Ravindra involved in protocol/project development and manuscript writing/editing. Dr. Ganpule Arvind involved in protocol/project development and manuscript editing. Dr. Jairath Ankush involved in data collection or management. Dr. Shah Darshan involved in data analysis. Dr. Desai Mahesh involved in data analysis and manuscript writing and editing.

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Authors and Affiliations

  1. MPUH, Nadiad, India

    Abhishek Gajendra Singh, Jaspreet Singh Chhabra, Ravindra Sabnis, Arvind Ganpule, Ankush Jairath, Darshan Shah & Mahesh Desai

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  1. Abhishek Gajendra Singh
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  2. Jaspreet Singh Chhabra
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Correspondence to Abhishek Gajendra Singh.

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Singh, A.G., Chhabra, J.S., Sabnis, R. et al. Role of flexible uretero-renoscopy in management of renal calculi in anomalous kidneys: single-center experience. World J Urol 35, 319–324 (2017). https://doi.org/10.1007/s00345-016-1881-8

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  • DOI: https://doi.org/10.1007/s00345-016-1881-8

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