Laparoscopic Heminephrectomy in a Horseshoe Kidney Affected by Xanthogranulomatous Pyelonephritis

Background and Objectives: Horseshoe kidney is a relatively common renal fusion anomaly. There are increasing reports of successful laparoscopic management of surgical disease in this entity. Xanthogranulomatous pyelonephritis (XGP) is an inflammatory condition of chronically obstructed and infected kidneys that is typically refractory to medical management. XGP has been regarded as a contraindication to laparoscopic surgery. Successful laparoscopic nephrectomies have been reported, albeit with high conversion and complication rates. In this report, we describe successful laparoscopic heminephrectomy for a horseshoe kidney moiety that was subsequently shown to have pathologic features of XGP. Methods: We report the case of a woman who underwent laparoscopic heminephrectomy for XGP of a horseshoe kidney. We discuss surgical technique and patient outcome. We also performed and report on a focused review of the relevant literature. Results: Pure laparoscopic heminephrectomy was completed by a transperitoneal approach. The patient was discharged the day after surgery. Conclusions: Laparoscopy is a viable approach for the management of XGP in horseshoe kidneys. However, this is a challenging procedure that should be the domain of advanced laparoscopic surgeons.