Different managements of horseshoe kidney stones, any difference in the outcome?

"Percutaneous Nephrolithotomy (PCNL) versus other treatments for stone management in horseshoe kidneys: A systematic review"

Urolithiasis represents the most frequent complication of horseshoe kidneys. All known approaches for stone disease management have been reported in these patients, including Extracorporeal Shockwave Lithotripsy, ureteroscopy, Percutaneous Nephrolithotomy, open surgery and laparoscopy. The purpose of this systematic review is to compare Percutaneous Nephrolithotomy with other least-invasive procedures in patients with horseshoe kidneys. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines, PubMed®, Scopus® and Cochrane® primary databases were systematically screened, from inception to 29 May 2023. Both prospective and retrospective comparative studies including patients with horseshoe kidneys and urolithiasis, who underwent Percutaneous Nephrolithotomy and other treatments for stones management, were eligible. Non comparative studies and case series were also included. A total of 10 studies met inclusion criteria and were included in final qualitative synthesis. In total 583 patient underwent Percutaneous Nephrolithotomy and other treatments for stone management in included studies. Stone free rates ranged from 57.1% to 88% for Percutaneous Nephrolithotomy, from 55.6% to 100% for ureteroscopy, from 27.3% to 83.3% for Extracorporeal Shockwave Lithotripsy and was 100% for pyelolithotomy and 71.4% for Percutaneous Nephrolithotomy in combination with ureteroscopy. Although percutaneous Nephrolithotomy was associated with more complications when compared to other treatment modalities, most of them were Grade I or Grade II ones, according to the Clavien-Dindo Classification System. Management of urolithiasis can be efficiently and safely accomplished in almost all cases of horseshoe kidneys. Extracorporeal Shockwave Lithotripsy, ureteroscopy, Percutaneous Nephrolithotomy and pyelolithotomy all represent excellent choices for the treatment of stones in these patients, being feasible, efficient and safe. Percutaneous Nephrolithotomy was associated with the highest stone-free rates, but also with the highest complication rates. Access should be ideally performed via the upper poles. Optimal stone management in patients with horseshoe kidneys depends on stone burden, stone location and surgeon's preference.

Combined laparoscopic pyelolithotomy with retrograde intrarenal surgery in a patient with horseshoe kidney anomaly and kidney stone: a case report

Horseshoe kidney is the most prevalent congenital kidney fusion anomaly, affecting 0.25% of the general population and occurring in 1 in 400-1600 births. Approximately 40 percent of patients develop kidney stones due to anomalies. In our case, we aimed to perform combined laparoscopic pyelolithotomy with retrograde intrarenal surgery (RIRS) instead of percutaneous nephrolithotomy (PNL) in a patient with a horseshoe anomaly. This procedure enabled us to detect the location of the mobile stone with RIRS and then successfully extract it with laparoscopic pyelolithotomy. Laparoscopic pyelolithotomy combined with RIRS is a reasonable additional treatment option for complicated stone surgery due to horseshoe kidney anomalies.

Single-Use vs Reusable Ureteroscopes in Horseshoe Kidney Stones

Introduction: Horseshoe kidney (HSK) is one of the most frequent renal malformations which appears to present an increased risk of stone formation caused by abnormal urine drainage. This study aims to compare the results of single-use flexible ureteroscopy (SUfURS) vs reusable devices (RfURS) with holmium laser in treating stones in HSK cases. Material and method: Between February 2017 and June 2021, 29 patients diagnosed with renal stone disease and horseshoe kidney were retrospectively analyzed. Subjects were divided into two groups: Group 1 (14 patients) undergoing SUfURS and Group 2 (15 patients) operated with RfURS devices. We analyzed the mean stone burden, operation time, stone free rate and complications. The surgical equipment was represented by the SUfURS PU3022 (Zhuhai Pusen Medical Technology) and RfURS URF-V2 (Olympus). Results: The two groups had a similar mean stone burden: 22 ± 6 mm (range 15-31 mm) for Group 1 and 24 ± 7 mm (range 16-30 mm) for Group 2. The average operative time was better for Group 1 (86 ± 17 min) vs Group 2 (89 ± 20 min). The stone-free status was similar for both groups after the first session (57.14% for Group 1 vs 53.33% for Group 2) and slightly in favor of Group 1 as compared to Group 2 (85.71% vs 73.33%, respectively) after the second session. The overall complication rate (Grades I, II and III) was almost similar in both groups, with a slightly prevalence for Group 1 (no major complications Grade IV and V). Conclusion:Flexible ureteroscopy represents an effective alternative treatment technique for large stones in kidney abnormalities. single-use flexible ureteroscopy can be successfully used to treat patients with genetically renal malformations and its results may be slightly better than those provided by using RfURS devices.

Comparison of the Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy and Flexible Ureteroscopy for Treatment of Urolithiasis in Horseshoe Kidney Patients: A Systematic Review and Meta-Analysis

Background: Urolithiasis is the most common complication of horseshoe kidney (HK), which can be treated by extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (FURS), and percutaneous nephrolithotomy (PCNL). When comparing treatments of ESWL and FURS, it is unclear which is more efficient and safe. The objective of this study was to compare the efficacy and safety of FURS and SWL for the treatment of urolithiasis in HK patients. Methods: A systematic search of the Web of Science, PubMed, and EMBASE was performed in February 2021. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in each study. Results: Five studies published between 2008 and 2018 were synthesized in the present meta-analysis. The study revealed that FURS compared with SWL had greater initial and overall stone-free rates (SFRs). Risk ratios (RRs) were 2.46 (P < 0.00001) in initial SFRs, 1.36 (P = 0.02) in overall SFRs. No differences were found in the retreatment ratio, RRs were 0.49 (P = 0.43). In addition, no major complications were encountered, and all the complications were mild to moderate. Conclusion: The study demonstrated that FURS and SWL are effective and safe treatments for patients with HK with stones (<20 mm). Moreover, FURS has greater clearance rates and lower complication rates than SWL.

Malformative Reno-Urinary Pathology in Patients with HIV Infection-Clinical and Therapeutic Implications

Chronic kidney disease is an important comorbidity of HIV infection causing real problems in the evolution and medical healthcare of HIV-positive patients. In recent years, a significant number of HIV-positive patients develop renal dysfunction, several mechanisms being incriminated: direct effect of the virus, toxic effect secondary to of antiretroviral medication, secondary to associated comorbidities, given that life expectancy has increased significantly in the last decade, thanks to the use of antiretroviral therapies. There are few studies in the literature to evaluate malformative renourinary pathology in patients with HIV infection. We present the case of a patient with HIV infection, horseshoe kidney, chronic kidney disease and incomplete Fanconi syndrome, secondary to the administration of tenofovir fumarate, a nucleoside reverse transcriptase inhibitor. Malformations, abnormalities or dysmorphysms of the renal tract should be considered in the HIV-positive patient with secondary renal dysfunction because they take a wide range of forms, are underdiagnosed and predispose to multiple complications, with varying degrees of severity, such as urinary tract infections, renal stones or progression of chronic kidney disease. Tenofovir fumarate and atazanavir must be avoided in patients with HIV infection and chronic renal dysfunction.