Percutaneous nephrolithotomy in ectopically located kidneys and in patients with musculoskeletal deformities.
OBJECTIVE
To assess the feasibility, safety and results of percutaneous nephrolithotomy (PNL) in ectopically located kidneys and in patients with musculoskeletal deformities.


METHODS
Thirteen such patients underwent PNL between June 2005 and May 2008. Mean stone size was 27.4 mm (16-37 mm). Six patients had severe kyphoscoliosis, 2 patients each had achondroplasia, cross-fused ectopia and pelvic ectopic kidney, and 1 patient had thoracic kidney. All had a preoperative CT scan of the abdomen. Preoperative ultrasound- or CT-guided percutaneous nephrostomy (PCN) was done in 10 patients. Three patients underwent laparoscopic-assisted PNL. All underwent standard PNL. The stone-free rate, complication rate and need for secondary intervention were evaluated.


RESULTS
PNL was successfully completed in all. A second ultrasound-guided intraoperative puncture was required in 2 patients. Re-look PNL was required in 1 patient and the same patient later required shock wave lithotripsy for complete stone clearance. The remaining 12 patients (92.3%) were rendered stone-free in a single sitting.


CONCLUSIONS
PNL is a feasible and effective modality in anomalous kidneys. Preoperative planning with CT and image-guided PCN is helpful in these situations. Laparoscopic-assisted PNL can be safely performed in patients where access to a renal collecting system by fluoroscopy or image-guided assistance (ultrasound or CT scan) is not possible.
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. anees772000 @ yahoo.com
A
A
Srivastava
P
P
Gupta
S
S
Chaturvedi
P
P
Singh
R
R
Kapoor
D
D
Dubey
A
A
Kumar
D000015:Abnormalities, Multiple; D000328:Adult; D000368:Aged; D002828:Choristoma / Q000150:complications* / Q000175:diagnosis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007194:India; D007668:Kidney / Q000000981:diagnostic imaging; D007669:Kidney Calculi / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009139:Musculoskeletal Abnormalities / Q000150:complications*; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D015641:Radiography, Interventional; D012086:Reoperation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional