Percutaneous nephrolithotripsy in a patient with stones in a horseshoe kidney and deformation of the vertebral column

Severe deformation of the vertebral column combined with the abnormalities of upper urinary tracts development leads to alterations of the topographical anatomy of the kidney. This condition accounts for additional difficulties in surgical access and creates prerequisites for a more thorough selection of the tactics of operative treatment. Today, percutaneous nephrolithotripsy (PNL) is regarded as the gold standard in treatment of kidney stone disease. Therefore, our aim was to evaluate the efficiency and safety of this method of operative treatment of a patient with the conditions mentioned above. The paper describes a clinical case of a step-by-step performance of PNL in a female patient, aged 54. The patient was diagnosed with the abnormality of upper urinary tracts development, stones in a horseshoe kidney, kidney stone disease, chronic pyelonephritis (remission), congenital left-side grade IV kyphoscoliosis at the level of Th X-XII. Considering the presence of bilateral staghorn nephrolithiasis, significant kyphoscoliotic deformation, and the data from general clinical examination, the first stage of treatment was PNL of the left part of the horseshoe kidney. During the second stage, PNL was performed on the contralateral part of the kidney. Early and late post-operative periods were not followed with any complications. As a result, the effectiveness of surgical intervention was 100% in this clinical case.