Percutaneous Nephrolithotomy (PCNL) in Kidneys with Fusion and Rotation Anomalies
Bannakit Lojanapiwat, MD*
Affiliation : * Division Urology, Department of Surgery, Chiang Mai University, Chiang Mai
Objectives : Fusion and rotation anomalies are among the most common anomalies of the kidneys especially
the horseshoe kidneys that have abnormal mixtures of malrotation, ectopia and fusion. Percutaneous neph-
rolithotomy (PCNL) in horseshoe kidney and malrotation kidney is challenging. We report PCNL in 10
horseshoe kidneys and 4 kidneys with congenital malrotation.
Materials and Methods : PCNL was done in 14 kidneys of 12 patients who had horseshoe kidneys (6 patients)
and malrotation kidneys (4 patients). Two patients with horseshoe kidney had bilateral calculi. One patient
had simultaneous PCNL. Upper pole access was done in 12 kidneys under fluoroscopic guidance with modi-
fied PCNL technique. Tubeless PCNL was done in 7 kidneys.
Results : Stone-free rate was 86% and the fragment of stones less than 4 mm was 14%. Only minimal pleural
effusion was found in one patient that no intervention was needed. Average hospital stay was 3.3 days.
Conclusion : Percutaneous nephrolithotomy (PCNL) in horseshoe kidney and malrotation kidney is effective
and a safe method in wish only a minor modified technique is needed. Upper pole access was used in most of
the cases. No increasing of the complications of PCNL in horseshoe kidneys and malrotion kidneys is found
comparing to the same procedure done in the normal kidney.
Keywords : Fusion and rotation anomalies, Percutaneous nephrolithotomy(PCNL)
