Huang L et al, 2018: Management of upper urinary tract calculi in crossed fused renal ectopic anomaly.
Huang L, Lin Y, Tang Z, Lie D, Wang Z, Chen H, Wang G.
Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China.
2Institute for Virology, University Hospital of Essen, University of Duisburg-Essen, D-45147 Essen, Germany.
The aim of the present study was to summarize the management of upper urinary tract calculi in crossed fused renal ectopia (CFRE). Two patients were retrospectively studied in Xiangya Hospital (Changsha, China) and all relevant literature published in English between 1996 and 2016 was reviewed. All patients, including those reported in the literature, were characterized by age, sex, manifestation, therapy history, ectopic side, stone location, surgery and outcome. The patients had a mean age of 42.3±18.5 years, a male: Female ratio of 5:4 and the ratio of renal ectopic side was 9:8 (left:right). All patients suffered from different degrees of pain on the affected side, with or without hematuria. Up to 89% of patients presented with renal stones. These patients received treatments including conservative management in 2, extracorporeal shock wave lithotripsy (ESWL) in 2, percutaneous nephrolithotomy (PCNL) in 11, laparoscope nephrolithotomy in 1 and retrograde intrarenal surgery (RIRS) in 3. Complete stone clearance was achieved in 14 patients (73.7%). In addition, 3 patients had a history of failed ESWL. No obvious intraoperative or postoperative complications occurred. The results suggested that, for the treatment of CFRE with upper urinary tract calculi, conservative treatment and ESWL are insufficient. PCNL is a safe and effective treatment for renal calculus, and laparoscopic nephrolithotomy is an alternative choice for treating large or staghorn renal stones. RIRS may become the first line of treatment for renal stones (≤3.5 cm) due to its multiple merits, including higher stone-free rates, minimal invasion and fewer complications.
Exp Ther Med. 2018 Jan;15(1):371-376. doi: 10.3892/etm.2017.5382. Epub 2017 Oct 27. FREE ARTICLE
It is easy to understand that the complex anatomy of CFRE is associated with outflow problems. Accordingly it is not surprising that SWL was not the most appropriate treatment option for stones located in the kidney.
In the two patients reported by the authors PCNL and URS obviously were used for removal of the ureteral stones. It seems likely, however, that SWL had been an alternative treatment for those stones. A look at the review of the literature showed that there was only one patient treated for a ureteral stone with SWL and that treatment was successful.
For the two patients presented by the authors my own preference probably had been to use SWL for the ureteral stones in order to shorten the duration of the invasive treatment