title: Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study.
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 (χ2), 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.
authors.affiliation: Endourologists, Vayodah and Venus International Hospitals, Kathmandu, Nepal.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Khadgi
authors.affiliation: Vayodah and Venus International Hospitals, Kathmandu, Nepal.|Department of Anaesthesiology, Kathmandu Medical College, Kathmandu, Nepal.
authors.forename: Babu
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: Urology Department, Fayoum University, Fayoum, Egypt.
authors.forename: Hamdy
authors.initials: H
authors.lastname: Ibrahim
authors.affiliation: Endourologists, Vayodah and Venus International Hospitals, Kathmandu, Nepal.
authors.forename: Sunil
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Urology Department, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt. mohammedshemy@yahoo.com.
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: ElSheemy
authors.affiliation: Kuwait University, Kuwait, Kuwait.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Al-Kandari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000000981:diagnostic imaging; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D008096:Lithotripsy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D000074642:Nephrolithotomy, Percutaneous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D016896:Treatment Outcome; D020709:Ureteroscopes; D055815:Young Adult
keywords: Anomalous kidney; Horseshoe kidney; Mini-percutaneous nephrolithotomy; Polycystic kidney; Renal stones