ABSTRACT
Although the general principles remain the same, approach to treat stones in anomalous kidneys must be tailored to the individual patient due to altered renal anatomy or ectopic position compared to the treatment strategies used in an anatomically normal kidney. It is essential to treat associated obstruction in addition to stones in an anomalous kidney (e.g., calyceal diverticulum, ureteropelvic junction obstruction in a horseshoe kidney). Therefore, it is not surprising that the reported stone-free rates after Extracorporeal Shock Wave Lithotripsy (ESWL) for patients with stones in a calyceal diverticulum or other anomalous kidneys with hydronephrosis are poor.(2, 3) A thorough metabolic evaluation including stone analysis, serum and 24-hour urine stone risk profile is mandatory in the work up to minimize stone recurrence and growth of small residual stone fragments into clinically significant ones in the above anatomically and technically challenging group of patients. For uric acid stones medical management to dissolve the stones should be the first line of treatment. This chapter describes the various treatment techniques and reported outcomes in the management of patients with stones in an anomalous kidney including stones in a transplant kidney.
