Category: Clinical Stones: Outcomes

MP31-14 - Outcomes of Ureterorenoscopy in Anomalous Kidneys: A Systematic Review

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

Treatment of urolithiasis in anomalous kidneys is challenging due to altered anatomy.  Advances in technology with modern day ureteroscopes and the holmium laser have enabled increasingly complex cases such as these to be undertaken using flexible ureterorenoscopy (FURS).  We undertook a systematic review to investigate the efficacy and safety of FURS for urolithiasis in anomalous kidneys.

Methods :

A systematic review of literature was conducted using PRISMA and Cochrane guidelines looking at MEDLINE, Scopus, EMBASE, CINAHL and the Cochrane library for all English language articles reporting on outcomes of FURS for management of urolithiasis in anomalous kidneys. Studies of all age groups (minimum 5 patients) were included from inception to December 2017.

Results :

Thirteen retrospective studies (425 patients) with a mean age 43.1 year (range 1-78 years) were included.  Renal anomalies included horseshoe kidney(HSK) n=221; ectopic kidney(EK) n=117; isolated malrotation(MR) n=81 and cross fused ectopia n=2.  Mean stone size was 16.3mm (range 2 - 35mm).  Holmium laser was used in 388 (91%) of cases.  The mean operative time was 64.9 minutes (range: 14-185).  

The mean initial and final stone free rates (SFR) was 69.5% and 77.7% respectively.

While the overall complication rate was 16.5% (n=70), there were 14.6% (n=62) Clavien I/II complications and 1.9% (n=8) Clavien III complications with no Clavien IV/V complications noted in the review.

Conclusions :

FURS in patients with anomalous kidneys can be technical challenging but offers effective outcomes with good SFR and low risk of major complications even for relatively large stones.

Lisa Lavan

Urology Registrar
University Hospital Southampton
Southampton, England, United Kingdom

Bhaskar K. Somani

Consultant Urologist, Associate Professor
University Hospital Southampton , U.K
Southampton, England, United Kingdom

Bhaskar is an Endourologist and Associate Professor in Southampton, and is an active member of European School of Urology 'Training and Research group' and ESUT Endourology group. He has been teaching on EUREP hands-on-training for the last 5 years and is the senior author in the new ‘Endoscopic stone treatment (EST)’ curriculum established for training and examinations. He has performed live surgery in EAU with presentations and moderations in EULIS, WCE and SIU. He is also a member of EAU ‘Train the Trainer’ committee.

He is research active and has published more than 200 papers with over 300 published abstracts/presentations. He is on the editorial board of 3 journals, a reviewer for 14 journals and Investigator for 5 trials. He sits on the MCQ panel for FRCS examinations and is a ‘Specialist advisor’ to National Institute of Clinical Excellence (NICE) Interventional procedures and ‘Invited expert’ to NICE urological infections. He is an elected member of BAUS Academic section and was recently selected as a Fellow of Faculty of Surgical Trainers.