Abstract
Urolithiasis represents the most frequent complication of horseshoe kidneys. All known approaches for stone disease management have been reported in these patients, including Extracorporeal Shockwave Lithotripsy, ureteroscopy, Percutaneous Nephrolithotomy, open surgery and laparoscopy. The purpose of this systematic review is to compare Percutaneous Nephrolithotomy with other least-invasive procedures in patients with horseshoe kidneys. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines, PubMed®, Scopus® and Cochrane® primary databases were systematically screened, from inception to 29 May 2023. Both prospective and retrospective comparative studies including patients with horseshoe kidneys and urolithiasis, who underwent Percutaneous Nephrolithotomy and other treatments for stones management, were eligible. Non comparative studies and case series were also included. A total of 10 studies met inclusion criteria and were included in final qualitative synthesis. In total 583 patient underwent Percutaneous Nephrolithotomy and other treatments for stone management in included studies. Stone free rates ranged from 57.1% to 88% for Percutaneous Nephrolithotomy, from 55.6% to 100% for ureteroscopy, from 27.3% to 83.3% for Extracorporeal Shockwave Lithotripsy and was 100% for pyelolithotomy and 71.4% for Percutaneous Nephrolithotomy in combination with ureteroscopy. Although percutaneous Nephrolithotomy was associated with more complications when compared to other treatment modalities, most of them were Grade I or Grade II ones, according to the Clavien-Dindo Classification System. Management of urolithiasis can be efficiently and safely accomplished in almost all cases of horseshoe kidneys. Extracorporeal Shockwave Lithotripsy, ureteroscopy, Percutaneous Nephrolithotomy and pyelolithotomy all represent excellent choices for the treatment of stones in these patients, being feasible, efficient and safe. Percutaneous Nephrolithotomy was associated with the highest stone-free rates, but also with the highest complication rates. Access should be ideally performed via the upper poles. Optimal stone management in patients with horseshoe kidneys depends on stone burden, stone location and surgeon's preference.