Wani M. et al., 2023: Challenges and options for management of stones in anomalous kidneys: a review of current literature.

Wani M, Mohamed AHA, Brown G, Sriprasad S, Madaan S.
Department Of Urology, Cardiff, and Vale University Health Board, Cardiff, UK.
Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham, UK.
Department of Urology, Dartford, and Gravesham NHS Trust, Dartford, UK.
Department of Urology, Royal Glamorgan Hospital, Rhondda Cynon Taff, UK.
Department of Urology, Dartford, and Gravesham NHS Trust, Darent Valley Hospital, Darenth Wood Road, Dartford, DA2 8DA, UK.
Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham ME4 4UF, UK.

Abstract

Introduction: Congenital anomalies of the kidney and urinary tract (CAKUT) represent a wide range of disorders that result from developmental abnormalities of the kidneys, urinary collecting tract, and lower urinary tract. There has been extensive development in approaches to the management of stones in normal kidneys with the advent of retrograde intra-renal surgeries (RIRS)/ureteroscopies, extracorporeal shock wave lithotripsy (ESWL) percutaneous nephrolithotomy (PCNL), and minimally invasive surgery (laparoscopy/robotics). However, the management of stones in CAKUT is not straightforward and is often challenging for urologists. There are no clear guidelines available to help navigate stone management in such patients.

Materials and methods: The aim of this literature review was to focus on stone management in anomalous kidneys. Most common abnormalities were considered. The studies were very heterogeneous with different approaches. The methodology involved evaluating studies looking into individual surgical approaches to the management of stones in these anomalous kidneys as well as looking at different approaches to stone management, in particular renal abnormality.

Results: We found RIRS is a feasible approach in most stones with sizes <20 mm and PCNL holds the upper hand in stones more than 20 mm. However, ESWL, laparoscopy, and robotics have their places in managing some of these cases.

Conclusion: We concluded that stones in anomalous kidneys can be challenging but can be managed safely. There is no straightforward answer to the right technique but rather the right planning based on the anatomy of the kidney in terms of vascularity and drainage, stone size and density, and expertise available.

Ther Adv Urol. 2023 Dec 24;15:17562872231217797. doi: 10.1177/17562872231217797. eCollection 2023 Jan-Dec. PMID: 38146488 Review. FREE ARTICLE