Category: Clinical Stones: PCNL
Introduction & Objective : To report on the outcomes of Percutaneous Nephrolithotomy (PCNL) in Horseshoe Kidneys (HSK) in 5 different institutions worldwide.
We performed a retrospective analysis of prospective databases, between 2008 and 2018, that included all PCNL in HSK. Pre, peri and postoperative data were collected and a subgroup analysis according the patient position was performed. Success rate was defined as absence of >2mm fragments on the control study. A p value <0.05 was considered statistically significant.
Results : A total of 72 surgeries in 56 patients were analysed. Demographic data, stone characteristics and operative parameters are reported in Table 1. The transfusion, complication and immediate success rates were 4.5, 15.2 and 53%, respectively. Final success rate increased to 66.1% after a mean of 0.3 secondary procedures. CT scan was the last image in 59% of the patients. When analysing surgeries according to the patient position, 56 patients (77.7%) were operated in prone and 16 (23.3%) in supine. Prone patients had a significantly higher BMI than supine group. The transfusion, complication and immediate success rates between prone and supine groups were 5.5% vs 0% (p=1), 21.7 vs 7.1% (p=0.277) and 48 vs 68.7% (p=0.389), respectively. Final success rate for prone and supine groups increased to 57 and 86.7% after 0.29 and 0.31 secondary procedures, respectively. CT scan was the last image in 56 and 75% of the patients, respectively. There were no higher than Clavien 3 complications in this series.
Conclusions : PCNL in HSK is a rare procedure. However, it is a safe and effective option with a low rate of complications. Despite the low number of patients, outcomes seems to be similar between prone and supine position when performing PCNL for HSK.
Fabio Vicentini– Endourology Unit, University of Sao Paulo and Brigadeiro Hospital, Sao Paulo, Sao Paulo, Brazil
Eduardo Mazzucchi– Head of Endourology Section, Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil, Sao Paulo, Sao Paulo, Brazil
Mario Sofer– Director of Endourology Unit, Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Tel Aviv, Israel
Petronio Melo– Resident, Brigadeiro Hospital, Sao Paulo, Sao Paulo, Brazil
Brian Eisner– Head Endourology Unit, Mass General Hospital, Needham, Massachusetts
Timothy Batter– B.A., Harvard Medical School, Boston, Massachusetts
Braulio Manzo– Endourologist, Hospital Regional de Alta Especialidad del Bajío, Leon, Guanajuato, Mexico
Karen Stern– Clinical Fellow, Cleveland Clinic Foundation, Cleveland, Ohio
Carlos Batagello– Research Fellow, Cleveland Clinic, Cleveland, Ohio
Manoj Monga– Head of the Endourology Unit, Cleveland Clinic Foundation, Cleveland, Ohio
University of Sao Paulo and Brigadeiro Hospital
Sao Paulo, Sao Paulo, Brazil
Fabio C. Vicentini, MD, PhD, Head of Endourology Unit at Brigadeiro Hospital, Sao Paulo, Brazil. Faculty of the Endourology Unit of the Clinics Hospital of the Unoversity of Sao Paulo, Sao Paulo, Brazil.
Head of Endourology Section
Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
Sao Paulo, Sao Paulo, Brazil
Director of Endourology Unit
Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University
Tel-Aviv, Tel Aviv, Israel
Head Endourology Unit
Mass General Hospital
Brian Eisner MD is Co-Director of the Kidney Stone Program at Massachusetts General Hospital, Harvard Medical School. His practices focuses on endourology and kidney stone disease
Hospital Regional de Alta Especialidad del Bajío
Leon, Guanajuato, Mexico
Dr. Braulio Manzo is a Urologist from Mexico, professor in chief of endourology fellowship at Hospital Regional de Alta Especialidad del Bajío and Professor at Guanajuato University.
Cleveland Clinic Foundation
Karen Stern MD is currently an Advanced Endourology and Stone Disease Fellow at the Glickman Urological & Kidney Institute of the Cleveland Clinic. She received her BA from Emory University, her medical degree from the University of Arizona and completed her Urology residency at the Mayo Clinic in Phoenix, Arizona. She previously served as the Resident Representative for the Western Section of the AUA and as the Chair of the Residents and Fellows Committee (RFC). She is currently the RFC Representative on the AUA Young Urologists Committee. She is a Mayo Clinic Scholar and will be returning to Mayo Clinic Arizona as a Senior Associate Consultant in July 2019.