Table 5.

Comparative of surgical approaches for the management of stones in anomalous kidneys.

Study	Characteristics	Procedure/results	Conclusion
Lim (2022) 13	Aim  To propose a framework that can aid urologists in making an informed choice between PCNL and RIRS in urolithiasis in anomalous kidneys Study  Retrospective, 20 centers globally based on propensity score-matched pair analysis. (PSM)	Patients  Overall cohort  Of the 569 patients, (males: 418, females: 151)  HSK-288, EK-129, MRK-152  PSM Group – PCNL versus RIRS  Of the 254 patients, (males: 200, females: 54)  HSK-153, EK-42, MRK-59 Stone characteristics  Size: single stone < 2cm – 230, single stone > 2 cm – 132, multiple stones – 207  PCM group – PCNL versus RIRS  Size: single stone < 2 cm – 97, single stone > 2 cm – 45, multiple stones – 112 Procedure  Overall: PCNL – 261, RIRS-308  PSM Group: PCNL – 12, RIRS-127 Complications  Overall: sepsis – 9%, hematuria – 5.8%, operation abandonment – 2.75%  PSM group: sepsis – 8%, hematuria – 4%, operation abandonment – 6.3%	This study highlights that both PCNL and RIRS are safe and feasible options in any anomaly but PCNL provides better SFR especially in HSK and ectopic kidneys and those with higher stone volumes
Singh (2018) 2	Aim  Algorithm approach to compare different procedures for stones in anomalous kidneys Study  Retrospective	Patients  Of the 179 patients, (males: 129, females: 50)  199 Renal units – HSK-85, PK+ Others – 47, MRK-33, ADPKD-14 Stone characteristics  Size: 67–454.7 mm2 DSA (Avg. 204.36 mm2)  Location: Pelvis: 90, calyxes: 66, Pelvis+ calyx: 27, Ureteric: 10 Procedure  HSK: 10 RIRS; 67 PCNL; 7 ESWL 7; 1 LP  MRK: 13 RIRS; 17 PCNL; 2 ESWL; 1 LP  PK: 16 RIRS, 29 PCNL; 2 ESWL  ADPKD: 3 RIRS; 6 PCNL; 3 ESWL; 2 LP Complications  Scored 1–3 on CD Score, none had CD 4 complication	The algorithm approach to stones was devised based on stone size (more or less 1.5 cm), density (more or less 1000 HU), and drainage of anomalous kidneys
Ergin (2017) 4	Aim  Compare different procedures Study  Retrospective	Patients  Of the 178 patients (males: 110, females: 60)  HSK-96, PK-42, MRK-40 Stone characteristics  Size: 13.4–28.4 mm (Avg. 18.7 mm)  Location: Pelvis: 79, upper calyx: 28, middle calyx: 36, lower calyx: 76 Procedure  HSK: 36 RIRS; 60 PCNL  MRK: 32 RIRS; 8 PCNL  PEK: 33 RIRS, 9 Lap. Pyelolithotomy Complications  Minimal with Laparoscopic procedure	PCNL, laparoscopic pyelolithotomy, and RIRS are useful and effective treatment modalities for urinary stones in kidneys with abnormal anatomy. According to the results of our study, RIRS is safer and a more satisfactory minimally invasive modality, and it could be used in these kidneys with small- and medium-sized calculi

ADPKD, adult polycystic kidney disease; CD, Clavien–Dindo complications; EK, ectopic kidney; ESWL, extracorporeal shock wave lithotripsy; HSK, horseshoe kidneys; LP, laparoscopic pyelolithotomy; MRK, Mal-rotated kidneys; PCNL, percutaneous nephrolithotomy; PK, pelvic kidney; RIRS, retrograde intra-renal surgery; SFR, stone-free rate; URS, ureterorenoscopy.