UROLITHIASIS IN HORSESHOE KIDNEYS - THERAPEUTIC MANAGEMENT

Objectives. We sought to compare the results of different therapeutic strategies in patients with horseshoe kidneys acid urolithiasis. Metho ds. The records of 47 patients (28 male, 19 female; mean age, 42 years ) with horseshoe kidney treated for urolithiasis from 1983 to 1994 wer e reviewed retrospectively and follow-up studies of 38 of 47 patients were obtained after 7 to 122 months (mean, 79). Results. Open surgery was performed in 6 patients with ureteropelvic junction obstruction; 1 required nephrectomy of a nonfunctioning right kidney and the other 5 are stone free. Percutaneous nephrolithotomy (PNL) was performed in 4 patients with normal drainage and a moderate to large stone burden; 5 became stone free and the other required extracorporeal shock-wave li thotripsy (ESWL) secondarily. In the remaining 37 patients with normal drainage and a small to moderate stone burden, ESWL achieved a 100% d isintegration rate and a 76% stone-free rate. Conclusions. The presenc e of anatomic obstruction will necessitate open surgery for urolithias is in patients with horseshoe kidney; however, in patients with normal urinary drainage PNL or ESWL can be considered, either singly or as a part of combination therapy. When management is tailored to the indiv idual patient's needs, results of stone treatment can be equivalent to those in normal kidneys.