Razi Journal of Medical Sciences

    Background & Aim: Patients with congenital renal abnormality are more prone to calculus formation and have less chance of spontaneous stone passage. Percutaneous treatment of patients with calculi in an abnormal kidney can be challenging due to the altered anatomical relationship in the retroperitoneum. Therefore, we performed a review to assess the safety and efficacy of this minimally invasive technique in patients with congenital renal abnormality. Patients and Methods: We performed percutaneous nephrolithotomy(PCNL) in 15 patients with calculi in anomalous kidneys. Mean age was 34.8 years and 53.3% of the patients were males. The type of anomaly, size of stone, tract site, number of tracts, stone-free rate, transfusion and complication rate and need for secondary intervention were evaluated. Results: Majority of patients had horseshoe kidney(46.7%), 2 cases had ectopic pelvic kidney and 6 others had malrotated and miniaturized kidney. Renal access was obtained through upper pole calyx in 53.3% of the cases, a lower calyx in 33.3% and a middle calyx in 13.3%. Only two cases needed 2 tracts and re-PCNL was performed in 3 cases. Pleural injury occurred in 2 patients and was managed conservatively. There was no need for transfusion. Meanwhile 13(87%) were completely and 2(13%) were relatively stone-free after first or second look procedures. Conclusion: Percutaneous treatment of patients with renal calculi in an anomalous kidney is technically challenging, usually requiring upper pole access. The high stone-free rate and a relatively low incidence of major complications suggest that this minimally invasive method is an effective means of stone management in this complex patient population.