asist. Simon Hawlina, dr. med, FEBU, asist. Tomaž Smrkolj dr. med, FEBU, asist. Jure Bizjak, dr. med, FEBU, asist. Borut Gubina, dr. med, FEBU, asist. mag. Dominik Cotič, dr. med, prim. Dr. Boris Sedmak, dr. med
Deapartment of Urology, University Clinical Center Ljubljana, Slovenia
Objective: Management of staghorn calculi in horseshoe kidney is complex in majority of cases. Anatomy is not typical, blood vessels are numerous which makes procedures more difficult. Surgery is treatment of choice in majority of cases, often in sequence. Open nephrolithotomy, laparoscopic nephrolithotomy, percutaneous nephrolithotomy and endoscopic lithotripsy are procedures of choice in management of staghorn stones. ESWL is employed when residual concrements present after primary treatment.
Purpose of case report: We are presenting a case report of patient with staghorn stone in horseshoe kidney. Minimal invasive procedures are feasible in treatment of big kidney stones. We would like to show the role of good diagnostic imaging before management of staghorn concrements, which is of great importance for optimal therapy.
Methods: Sixty-three years old patient came to our clinic with right lumbar pain. Ultrasound imaging showed 5×2 cm big stone in right side of horseshoe kidney with hydronephrosis. Blood laboratory findings were within normal limits. Renal scintigraphy showed obstructive curve with hypofunction of right side of horseshoe kidney (30%). At this time we considered an open nephrolithotomy. Before operation we ordered CT of abdomen with contrast. We changed our therapeutic decision and chose laparoscopic nephrolithotomy, because CT images showed a dilated pielon accessible with laparoscopy. After operation we found residual concrement. So we performed percutaneous nephrolithotomy in next few months. In the follow-up renal scintigraphy showed no obstructive curve any more and stable kidney function (29%). The patient was very satisfied with chosen treatment and was alleviated of pain.
Conclusion: Management of staghorn stones in a horseshoe kidney is complex in majority of cases. Anatomy is not typical, blood vessels are numerous which makes procedures difficult. Minimal invasive procedures are feasible in treatment of big kidney stones. Blood loss is minimal, patients return to daily activities faster, postoperative pain is diminished and finally, aesthetical results are better. In the diagnostic work-up it is essential to obtain good diagnostic imaging to choose proper operative method. Author’s advice is to make CT of abdomen with contrast before making any procedure.