A narrative review on extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy in patients with anomalous kidneys.

Abstract

Introduction: The aim of this paper was to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) in kidney stone patients with Congenital Anomalies of the Kidney and Urinary Tract (CAKUT).

Evidence acquisition: A literature search was performed on 15th November 2023 and updated on 18^th October 2024 using Cochrane Central Register of Controlled Trials, PubMed, Scopus and Google Scholar with no date limit. Preclinical and animal studies, reviews, letters to editor, case reports, pediatric studies were excluded. Only English papers were included.

Evidence synthesis: Forty-one articles were accepted. Seventeen studies focused on horse-shoe kidney (HSK). Among these, 3 papers focused on RIRS, 9 on PCNL, 5 compared RIRS vs PCNL. The remaining ones explored SWL, RIRS, PCNL in ectopic, malrotated and medullary sponge kidney and caliceal diverticulum stones. HSK, caliceal diverticulum and malrotated kidneys stones treated with SWL have poor stone-free rate, while the best choices are PCNL and ureteroscopy. In ectopic kidneys the best choice is ureteroscopy, SWL has poor stone-free rate, while PCNL is less safe for higher bowel injury risk. In medullary sponge kidneys regardless of the treatment used, stone-free rate is low, with a higher rate of retreatment.

Conclusions: SWL has lower stone-free rate and higher retreatment in all types of CAKUT but has the lowest rate of complications. PCNL has the best stone-free rate in large stone burdens and RIRS is effective procedure although higher reintervention rate and need of pre-stenting in some cases.