Surgical Management of Urolithiasis in Patients With Congenital Kidney Abnormalities

Background: Urolithiasis, a common renal complication, presents unique challenges when occurring in patients with congenital kidney abnormalities. Anatomical anomalies such as horseshoe kidney, ureteropelvic junction obstruction (UPJO), and kidney duplication complicate stone management because of altered urinary dynamics and access challenges. Study Question: How do congenital anatomical kidney anomalies affect stone burden and surgical outcomes, and what treatment approaches yield optimal results in these patients? Study Design: A retrospective analysis was conducted on 27 patients with urolithiasis in anomalous kidneys treated between 2019 and 2024. Measures and Outcomes: Patients were evaluated using laboratory tests and imaging modalities, including CT and ultrasonography, to plan appropriate surgical interventions. Data included demographics, stone characteristics (size, density, and location), anatomical abnormalities, and surgical parameters. Surgical outcomes, including stone-free rates, complications, and hemoglobin drop, were analyzed. Results: The cohort had a mean age of 47.3 years, with men comprising 62.9% of cases. Anatomical abnormalities included ureteropelvic junction obstruction (55.5%), duplication (25.9%), and horseshoe kidney (18.5%). The mean stone burden was 30.9 ± 17.0 mm, and staghorn stones were observed in 40.7% of cases. Open surgical interventions accounted for 59.2% of treatments, achieving a stone clearance rate of 85.8%. Percutaneous nephrolithotomy demonstrated a favourable minimally invasive profile with comparable success with open surgery, particularly for large or high-density stones. Conclusions: Effective management of urolithiasis in congenital kidney anomalies requires individualized treatment strategies. Percutaneous nephrolithotomy offers a minimally invasive option with high success rates, although complex cases may necessitate open surgery. Comprehensive preoperative planning is essential to optimize outcomes and minimize complications, emphasizing the need for specialized multidisciplinary care.