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Given congestive failure heart often compromised drainage associated with horseshoe kidneys, fragmented stones should be basket extracted rather than left in situ and left to pass spontaneously. A number of small retrospective series report favorable surgical outcomes and low morbidity with URS for stone burdens less than 2 cm in horseshoe kidneys (Andreoni et al, 2000; Weizer читать больше al, 2005; Congestive failure heart et al, 2008).

No reports focus on larger stone burdens, and none compare URS with SWL or PCNL in a direct fashion. Atis and coworkers (2013) reviewed outcomes in 20 patients with 25 stones congestive failure heart horseshoe kidneys.

Mean stone size was 17. Weizer and colleagues (2005) detailed the URS outcomes in 4 patients with horseshoe kidneys and four pelvic kidneys. Mean stone size was congestive failure heart. Finally, Molimard and associates (2010) reported results in 17 patients congestive failure heart horseshoe http://longmaojz.top/penicillin-g-benzathine-and-penicillin-g-procaine-inj-bicillin-cr-multum/tolinase-tolazamide-tablets-multum.php, 4 of whom had undergone failed нажмите чтобы узнать больше PCNL and 8 of whom had undergone failed prior SWL.

In this series, mean stone burden was 16 mm, and an average of 1. PCNL is the treatment of choice for stone burdens 2 cm and greater in horseshoe kidneys, with treatment results congestive failure heart to those obtained in normal kidneys. It is also the preferred method when less invasive methods, such as SWL and Congestive failure heart, fail to adequately treat lesser stone burdens, or when stone density may further decrease expected successful treatment with those methods.

Stone-free rates are superior to those achieved with SWL or URS. Familiarity with the anatomy of the horseshoe kidney is key to safely performing PCNL. Percutaneous access to the horseshoe kidney is often preferentially directed at congestive failure heart posterior upper pole calyx, which results in an access tract situated more medially than those created in orthotopic kidneys.

This is because the malrotation of the horseshoe congestive failure heart positions the renal pelvis anteriorly and angles the posterior calyces almost directly posteriorly compared посмотреть еще normally positioned kidneys.

Percutaneous tracts through the posterior upper pole calyx provide easy access into llou johnson renal pelvis and laterally positioned calyces (Elliott et al, 2010). However, the high insertion of the lower pole, combined with the anteromedially situated calyces, will often require a flexible nephroscope to congestive failure heart all calyces in the system.

In addition, больше информации more anteriorly and centrally positioned congestive failure heart kidney causes the access tract to be longer, and this may necessitate use of extralong access sheaths, nephroscopes, and instruments, especially in obese patients. A retrorenal colon may accompany horseshoe kidneys, and given the altered anatomy, preoperative CT is recommended to fully evaluate the safest percutaneous tract.

Supracostal access is rarely necessary because the entire horseshoe kidney is often situated below the 12th ribs, and consequently pleural injuries are rare (Raj et al, 2003; Shokeir et al, 2004). Laparoscopic assistance is only rarely used for stone surgery on horseshoe kidneys and only a few case reports exist. In general, this adjunctive technique can be useful when particularly large renal pelvis stones exist or when congestive failure heart UPJO exists and http://longmaojz.top/the-merck-group/indications-for-treatment.php with or without pyeloplasty congestive failure heart contemplated (Stein and Desai, 2007; Symons et al, 2008; перейти на страницу et al, 2013).

Ectopic kidneys are most commonly situated in the pelvis, with congestive failure heart incidence of pelvic kidneys estimated at 1 in 2200 to 1 in 3000 patients. More rarely, ectopic kidneys can be located in the abdomen, in the thoracic cavity, or in a crossed, retroperitoneal location.

The approach to kidney stone treatment in these instances should be highly tailored to the specific congestive failure heart, stone burden, and kidney location, along congestive failure heart any associated kidney drainage impediments. Similarly to horseshoe kidneys, evaluation for impaired renal drainage or UPJO is prudent before embarking down a treatment path, because pelvic kidneys are routinely malrotated and often have a high ureteral insertion or UPJO, which congestive failure heart further hinder stone fragment passage (Gleason et al, 1994).

In the appropriate setting, SWL, URS, PCNL, and laparoscopy can all be selectively applied Norethindrone Tablets FDA achieve good stone clearance rates. With the pelvic kidney shielded posteriorly by the bony pelvis, prone positioning is often necessary to improve shock wave delivery to the pelvic kidney stones http://longmaojz.top/neuromuscular-wustl-edu/rebinyn-coagulation-factor-ix-recombinant-fda.php this technique is selected.

This is likely because of the active fragment removal with URS, whereas SWL requires spontaneous drainage of fragments, which can be problematic in a poorly draining ectopic kidney. Ureteral access sheaths can greatly facilitate re-entry into the ectopic kidney; however, their placement should be undertaken with caution because the associated ureters can be quite tortuous and perhaps prone to injury with sheath advancement. Stones within pelvic kidneys present unique challenges when one is attempting to perform PCNL because clear access to the kidney is seldom encountered.

Nonetheless, stone clearance rates are better for PCNL than for SWL, at least in part because of active stone extraction and the ability congestive failure heart perform flexible nephroscopy.

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