Clinical & Medical Case Reports

Biography

Biography: Mohamed Breish

Abstract

Horseshoe kidney (HSK) is the most common congenital renal fusion anomaly with incidence of 1/400 the majority of which are incidental findings. HSK is characterized by malrotation of kidney, altered blood supply and tendency to form pelvi-ureteric junction obstruction in 30% of the cases which can be asymptomatic. However, HSK may present with complications such as urinary tract infections (UTI), stone formation and obstruction. Nephrolithiasis which is seen in 20% of cases of HSK is considered one of the most common indications for surgery. Indeed, the anatomical abnormalities challenge the treatment of stones in HSK. For instance, due to caudal and medial location of calyces, and the abnormal anterior position of the kidney, extracorporeal shock wave lithotripsy (ESWL) fails to achieve the same success rate in HSK. Percutaneous nephrolithotomy (PCNL) is also associated with major complications in anomalous kidney. Thanks to recent advancements of laparoscopic instrumentation and techniques, laparoscopic surgery continues to emerge as a promising alternative for stone treatment in HSK. We present a case of a 61-year-old lady who presented initially with recurrent UTI irresponsive to multiple courses of antibiotics. Urine cultures confirmed positive E. coli. Ultrasound sonography showed duplex kidney with multiple stones in the right kidney. CT scan revealed HSK with multiple right renal stones (35 mm in right lower pole with eight stones of 2-4 mm in size) associated with severe hydronephrosis of the right kidney. Th e patient was treated successfully with laparoscopic nephrolithotomy. Our case demonstrates that laparoscopy is an effective and safe approach in treatment of greater than 2 cm renal stones in HSK.