Extracorporeal shockwave lithotripsy in anomalous kidneys

Background and Objective: Extracorporeal shockwave lithotripsy (SWL) is acc epted as first-line therapy for kidney stones, The aim of this study was to evaluate SWL therapy in patients with congenital urinary system anomalies. Patients and Methods: A total of 120 patients with congenital urinary syste m anomalies and kidney stones who underwent SWL treatment were evaluated. O f these patients, 44 (37%) had horseshoe kidneys, 22 (18%) had rotation ano malies, 13 (11%) had pelvic kidneys, and 41 (34%) had ureteral duplications , The mean stone size was 2.09 +/- 0.71 (range 0.8-4.6) cm(2), and a total of 232 sessions (1.93 sessions/patient) were applied, Results: The overall stone-free rate after completion of the SWL treatments was 70% (84 patients). In horse shoe kidneys the stone-free rate was 68%, and sufficient fragmentation was achieved in another 21%, These values were 59% and 32%, respectively, for malrotated kidneys, 54% and 39% for pelvic kidneys, and 83% and 12% for ureteral duplications, The 10 patients in whom SWL treatment remained unsuccessful had horseshoe kidneys (five cases), ma lrotated kidneys (two cases), pelvic kidney (one case), and ureteral duplic ation (two cases). Open surgery was performed in eight patients with renal anomalies, and ureteroendoscopic lithotripsy was performed in two patients with ureteral duplication. Conclusion: Shockwave lithotripsy is an effective and reliable treatment me thod in patients with congenital urinary system anomalies, especially when the stones are <2 cm, Patients with ureteral duplication had the overall be st stone-free rates. However, patients who have stones greater than or equa l to 3 cm in horseshoe or malrotated kidneys and duplex systems seem to be better candidates for percutaneous nephrolithotomy or open surgery.