Flexible Ureterorenoscopy for Management of Renal Stone in Anomalous Kidneys: A Single Centre Experience

Background and Objective: Flexible ureterorenoscopy is a well-established treatment for renal calculi in anatomically normal kidneys. our objective is to evaluate the efficacy and safety of retrograde intrarenal surgery for managing renal stones in patients with renal abnormalities. Methods: A retrospective study was performed on 20 patients diagnosed with renal stones and kidney abnormalities who underwent primary retrograde intrarenal surgery, between October 2021 and October 2023 in Sulaymaniyah Teaching Hospital. The evaluation included demographic data, stone attributes, surgical specifics, and postoperative results. Success was defined as the complete removal of stones, confirmed by ultrasonography and x-rays at 1- and 3-months post-operation. Results: The cohort included 7 patients (35%) with divergent collecting systems, 6 patients (30%) with horseshoe kidneys, 5 patients (25%) with ectopic kidneys, and 2 patients (10%) with renal malrotation. The mean age was 43.2 ± 13.8 years, the mean body mass index was 27.8 ± 3.6 kg/m², and the average stone size measured 13.7 ± 3.7 mm. After one session, 75% of patients achieved complete stone removal, and 100% after the second session. Stone size and using access sheaths correlated with the rate of stone-free outcomes (P<0.5). Five patients, representing 25% of the total, experienced minor postoperative complications, including fever in four and hematuria in one patient. Conclusion: Despite the technical challenges associated with altered renal anatomy, Flexible ureterorenoscopy has demonstrated promising outcomes in managing renal calculi in abnormal kidneys, achieving satisfactory stone removal and acceptable complication rates.