ISSN: 2578-4676
Authors: Dhangar SP*, Vaidya S and Shengal M
Background: The incidence of anomalous kidney varies from 3-11%. Various types of anomalous kidneys exist like simple ectopic kidney, malrotated kidney, horse-shoe kidney, crossed fused ectopia, kidneys with duplex system and pelvic kidney etc. Treatment of stone disease in such kidneys is a bit different because of abnormal orientation of kidney, abnormally placed calyces and high incidence of abnormal renal vessels. Various options to deal with the stone in such kidneys include – ESWL, RIRS, PCNL, laproscopy assisted PCNL and laproscopic/robotic pyelolithotomy. Among these, PCNL is one of the recommended modalities to deal with stone disease in anomalous kidneys with the highest success rate for stone clearance. Primary aim of the study was to assess the success of PCNL in anomalous kidneys in terms of the stone clearance. Secondary aims were perioperative and postoperative complications. Methods: This retrospective study was done in SMBT IMS & RC, Nashik, India from August 2016 to July 2021. All patients were evaluated preoperatively with history, clinical examination, and blood and urine investigations, X-ray KUB, USG KUB, CT KUB and IVP. For statistical analysis, SPSS 19.0 software was used. We used standard PCNL technique of puncture followed by serial dilatation of the tract to the desired size. Minimum size of Amplatz sheath used was 20 Fr and maximum were 26 Fr. Results: Total 29 sessions of PCNL was done in 26 patients. Mean age of the patients were 30.6 years and duration of symptoms was 1-2 years. Mean haemoglobin drop was 0.8mg/dl with only three patients requiring blood transfusion. The operating time ranged from 80-120 minutes and average hospital stay was 3.8 days. Clavein grade 1 and grade 2 complications were recorded and were managed conservatively. Overall, the stone free rate immediately after surgery was 92.3% and 100% after 3 months for stone less than 4mm. Conclusion: PCNL in anomalous kidneys is technically demanding procedure but it gives much better results when compared other modalities of treatment. It is as safe as the PCNL done for a normal situated and oriented kidney. Infact, it increases the surgeon’s skills and make him more demanding for the complex cases.
Keywords: PCNL in Anomalous Kidney; Horse-Shoe Kidney; Crossed Fused Ectopia; Duplex Kidney; Ectopic Kidney; Ectopic Kidney
