Percutaneous nephrolithotomy of the horseshoe kidneyfactors affecting success

Objective: It was aimed to evaluate the factors affecting the surgical stone-free rate in horseshoe kidney patients who underwent percutaneous nephrolithotomy. Materials and methods: 188 horseshoe kidney patients who applied to our clinic at İnönü University Turgut Özal Medical Center between 2009 and 2023 were identified. A 24-unit percutaneous nephrolithotomy operation was performed on 19 of these patients. Each surgical unit was evaluated independently. The patients were divided into two: Group A, 9 units with post-operative residual stones, and Group B, 15 units with no post-operative residual stones. Between groups; Differences in age, gender, surgical history, additional comorbidities, renal anomalies, stone areas, number of stones, stone location, Guy's Stone scoring, Houns-field unit, PNL type and puncture area, stone-to-skin distance, and hospitalization time were evaluated retrospectively. Our study included adult and pediatric patients with horseshoe kidneys who underwent percutaneous nephrolithotomy and whose pre-operative and post-operative follow-up and treatments were arranged in our clinic. Results: 9 units in Group A and 15 units in Group B were compared. In the comparison of demographic data between groups; No statistical difference was observed between age, gender, additional diseases and renal anomalies (p>0.05). Previous surgical history was statistically significant between groups (p<0.05). In the comparison of pre-operative stone characteristics between groups; No significant difference was observed between the groups in terms of stone number, stone location, Guy'stone scoring, and Houns-field unit of the stone (p>0.05). The difference in stone area between groups was found to be statistically significant (p<0.05). In the comparison of intra-operative and post-operative differences between groups; No statistical difference was observed in parameters such as PNL type and puncture area, stone-to-skin distance, post-operative nephrostomy, complications and hospitalization time (p>0.05). In the logistic regression analysis of significant factors such as stone area and previous surgical history, it was observed that stone area was an independent factor (p<0.05). Conclusion: Percutaneous nephrolithotomy is a type of surgery that can be safely applied in horseshoe kidney patients, and in our study, it was observed that the stone area parameter alone affected surgical success as an independent factor. Keywords; Percutaneous nephrolithotomy, horseshoe kidney, stone-free rate