Laparoscopic Nephrolithotomy in a Horseshoe Kidney

Horseshoe kidney (HSK) is the common renal fusion congenital anomaly, affecting about 0.25% of the global population. Although most HSKs are detected incidentally, they may present with clinical findings, including urinary tract infections (UTI), stone formation, and obstruction. Nephrolithiasis, observed in 20% of patients with HSK, is a frequent indication for surgery. Due to the caudal and medial locations of calyces and the abnormal anterior position of the kidney, extracorporeal shock wave lithotripsy has shown a relatively low success rate in treating HSK. Percutaneous nephrolithotomy has also been associated with major complications in anomalous kidneys. Advances in laparoscopic instrumentation and techniques have made laparoscopic surgery a promising alternative for stone treatment in HSK. This report describes a 61-year-old woman who presented initially with recurrent UTI unresponsive to multiple courses of antibiotics. Urine cultures were positive for Escherichia coli. A computed tomography scan showed a right HSK with multiple renal stones (35 mm in the right lower pole with eight stones 2-4 mm in size), along with severe hydronephrosis. The patient was treated successfully with laparoscopic nephrolithotomy, indicating that laparoscopy is an effective and safe approach in the treatment of renal stones >2 cm in HSK.