الفهرس 
treartment of stones in ectopic kidneysOnly 14 pages are availabe for public view
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Abstract
Patients with stones in kidneys with congenital anomalies represent a challenge for treatment. Historically, most of those patients were treated with open surgery (Torres et al 1988). Currently, and after the marked improvements in technology and availability of wide variety of instrument, minimally invasive modalities (such as ESWL, flexible URS and PCNL) have almostly replaced open surgery. In treatment of stones in ectopic kidneys, ESWL has its place in the fragmentation of stones, but not really in stone clearance. It is recommended only for small stones and when urinary drainage is not hindered. A pragmatic approach to stone management is advised, with patients failing ESWL being considered for retrograde intrarenal surgery with ureterorenoscopy and holmium laser at an early stage (Willis et al., 2004). Laparoscopic assisted PCNL and laparoscopic pyelolithotomy avoid complications caused by anatomical abnormalities. Laparoscopic approach is also helpful in patients with associated UPJO because pyeloplasty can be done simultaneously (Gupta et al., 2006). Laparoscopic assisted PCNL has best results in dealing with large caliceal stones and failed ESWL in ectopic kidney (Elkappany et al., 2007). In horseshoe kidneys, small stones are best managed by ESWL, and stones that have failed management by ESWL or that are larger than 2 cm are best managed by PCNL. Ureterorenoscopy or ESWL is associated with more residual stone rate than the percutaneous approach. However, PCNL was associated with more complicates. The limited number of studies and the small number of patients limited our ability to obtain solid conclusions (Raj et al., 2003). Therapeutic planning for calculous disease in patients with ADPKD must consider the pathologies of both conditions. The status of each patient should be individualized. Despite the anatomical kidney distortion and patient’s medical complexity, PCNL is a safe and efficacious approach in ADPKD cases (Umbreit et al., 2010). It has a satisfactory stone-free rate and accepted morbidity. The outcome and complications are comparable to the already published results of PCNL in the kidneys with normal anatomy (Al-Kandari et al., 2009). Open lithotomy was traditionally done in ADPKD cases but less invasive forms of intervention should now be applied (Umbreit et al., 2010). In duplex Kidney, upper tract urinary stasis is common, the lower pole of the duplex system is dependent and may have impaired clearance of fragments after ESWL. Most of patients with duplex system had either lower pole or multicaliceal (including the lower pole) stones (Sheir et al, 2003). Malrotated kidneys are characterized by; abnormal renal and calyceal orientation, abnormal relations of the calices to the renal pelvis and upper ureter, relative renal immobility interfering with maneuverability of the equipment, abnormal renal relations with other intra abdominal organs, and abnormal dispensation of renal vasculature (Rana and Bhojwani, 2009). Finally the choice of treatment in patients with congenital renal anomalies requires strategic planning after studying all preoperative laboratory and radiological investigations. It is important to discuss with the patients the options of treatment and the reported out comes of each. The decision is usually individualized in each case depending on many factors such as the patients general condition, renal function, stone burden, surgeon experience and available instruments.