To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during surgery.
We performed a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK.
Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. ; p-values <0.05 were considered significant.
We analyzed 106 surgeries. The transfusion, complication, and immediate success rates were 3.8%, 17.5%, and 54.7%, respectively. The final success rate increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments ≥4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine. The prone group had a significantly higher BMI than the supine group (30.1 vs, 27.7, p=0.024). The transfusion, complication, and immediate success rates between the prone and supine groups were 4.5% vs. 2.6% (p=0.99), 16.9% vs. 18.4% (p=0.99), and 52.5% vs. 69.2% (p=0.151), respectively. Surgical time was significantly longer in the prone group (126.5 vs. 100 minutes, p=0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p<0.001). The prone group had significantly more Clavien 2 complications than the supine (p=0.013). The final success rate in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred.
PCNL in HSK patients is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.
Journal of endourology. 2020 Apr 15 [Epub ahead of print]
Fabio Carvalho Vicentini, Eduardo Mazzucchi, Mehmet Ilker Gökce, Mario Sofer, Yiloren Tanidir, Tarik Emre Sener, Petronio Augusto de Souza Melo, Brian H Eisner, Timothy Batter, Thomas Chi, Manuel Armas-Phan, Cesare Scoffone, Cecilia Cracco, Braulio Omar Manzo, Oriol Angerri, Esteban Emiliani, Orazio Maugeri, Karen Stern, Carlos Alfredo Batagello, Manoj Monga
University of Sao Paulo Hospital of Clinics, 117265, Urology, Sao Paulo, São Paulo, Brazil., University of Sao Paulo Hospital of Clinics, 117265, Division of Urology, Sao Paulo, São Paulo, Brazil; ., Ankara University Faculty of Medicine, 63990, Urology, Ankara, Ankara, Turkey; ., Tel Aviv Sourasky Medical Center, 26738, Urology, Tel Aviv, Israel; ., Marmara University School of Medicine, 64050, Urology, Istanbul, Turkey; ., Marmara University School of Medicine, 64050, Urology, Istanbul, Turkey; ., Hospital Brigadeiro, 58807, Urology, Sao Paulo, São Paulo, Brazil; ., Massachusetts General Hospital, 2348, Urology, Boston, Massachusetts, United States; ., Massachusetts General Hospital, 2348, Urology, Boston, Massachusetts, United States; ., University of California San Francisco, 8785, Urology, San Francisco, California, United States; ., University of California San Francisco, 8785, School of Medicine, San Francisco, California, United States; ., Hospital Cottolengo, 46961, Division of Urology, Torino, Piemonte, Italy; ., Hospital Cottolengo, 46961, Department of Urology, Torino, Piemonte, Italy; ., Hospital Regional de Alta Especialidad del Bajio, 126671, Urology , Leon, Guanajuato, Mexico; ., Puigvert Foundation, 16444, Urology, Barcelona, Catalunya, Spain; ., Puigvert Foundation, 16444, Urology , Barcelona, Catalunya, Spain; ., Ospedale Santa Croce, 9244, Cuneo, Italy; ., Cleveland Clinic, 2569, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States; ., Cleveland Clinic, 2569, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States., Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/32292038