title: Percutaneous nephrolithotomy in patients with kidney malformations.
abstract: OBJECTIVE
  Percutaneous nephrolithotomy (PCNL) for complex calculi within malformed kidneys can be challenging because of the abnormal anatomy. We present our 7-year experience with PCNL in such patients.
  
  
  METHODS
  We performed PCNL on 16 patients with complex calculi and anomalous kidneys, including 7 with horseshoe kidneys, 5 with rotation anomalies, 3 with ectopic kidneys, and 1 with a small kidney. After appropriate preoperative evaluation, the procedure was performed by choosing either anterior or posterior approaches depending on the kidney anomaly. When required, ultrasonography, laparoscopy, or both were used, as well as fluoroscopy to control the procedures.
  
  
  RESULTS
  A single-stage PCNL resulted in complete clearance in 13 patients (81%). A second-look procedure, alone or followed by shockwave lithotripsy, conferred stone clearance in one patient with a malrotated kidney and two with staghorn calculi in horseshoe kidneys. More than one tract was needed in two patients. The procedure was guided by laparoscopy in two patients with calculi in ectopic left kidneys. Serious complications were not encountered.
  
  
  CONCLUSIONS
  Patients with malformed kidneys and complex calculi can be managed safely and effectively with PCNL when they are properly selected and appropriately assessed before operation.
authors.affiliation: Department of Urology, Ekbatan Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Seyed Habib
authors.initials: SH
authors.lastname: Mosavi-Bahar
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Amirzargar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rahnavardi
authors.forename: Seyed Mohammadmehdi Hosseini
authors.initials: SM
authors.lastname: Moghaddam
authors.forename: Hoshang
authors.initials: H
authors.lastname: Babbolhavaeji
authors.forename: Shahryar
authors.initials: S
authors.lastname: Amirhasani
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000601:surgery*; D007669:Kidney Calculi / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D009929:Organ Size; D018579:Patient Selection; D016896:Treatment Outcome