Percutaneous Nephrolithotomy in Horseshoe Kidneys: Results of a Multicentric Study

Recently the paper “Percutaneous Nephrolithotomy in Horseshoe Kidneys” by Vicentini et al. was published in the Journal of Endourology exploring new ways of performing stone surgery in complex cases. This is the result of a multicentric collaboration of 12 centers that had pioneered this newly described approach of stone disease in horseshoe kidneys (HSK).

Due to the infrequent approach, many centers had to be involved to achieve an outstanding 106 patient series. From an anatomical point of view, HSK calices are displaced toward the posterior end patients, and the common approach of prone percutaneous nephrolithotomy (PCNL) for the upper pole access has made the supine PCNL for such patients unusual.

The key aspects of the study are that the dogma could be reinterpreted. Not every PCNL in HSK has to be done in a prone position. This also shows that the upper calyx can be accessed in supine PCNL. The article opened a new door in endourology showing that supine PCNL is safe and effective in HSK (taking into consideration the patient's BMI and stone size). Although a systematic and careful evaluation with a proper CT has to be made before each case, we now have more options to decide which could be the best approach for our patient.

Written by: Esteban Emiliani, MD, PhD, FEBU, Consultant Urologist, Fundación Puigvert, Department of Urology, Endourology and Urolithiasis unit, Autonomous University of Barcelona, Spain, Twitter: @emiliani_e

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