Introduction: Horse shoe kidney (HSK) is considered as the most common fusion anomaly with an incidence of 1 in 400-666 births. According to AUA and EAU guidelines, PCNL is the surgical modality of choice for renal calculi more than 2 cms even in case of HSK. In this case series, we describe our experience with prone PCNL in the management of nephrolithiasis in HSK over the last 10 years.

Methods: Retrospective analysis of hospital records yielded data of 22 patients who underwent prone PCNL for HSK calculi between June 2012 and May 2022. Patient characteristics and stone characteristics were recorded. Procedure related outcomes like number of tracts established, total procedural time, need for auxiliary procedures, stone free rate and postoperative complications according to modified Clavien Dindo classification were tabulated and analyzed.

Results: Mean age of patients in this study was 44.2 years ranging from 9 to 70 years. Mean stone surface area was 376.54 mm2. Single subcostal upper pole calyceal puncture and tract was able to clear the calculi in 18 cases. Supracostal punctures were required for 4 patients. Auxiliary procedures like redo-PCNL and ESWL were needed in 1 and 2 patients respectively. Blood transfusion was done in 2 patients. Primary stone free rate of82.7% and final stone free rate of 95.5% was achieved.

Conclusion: Prone PCNL is equally safe and efficient management strategy for the treatment of calculi in horse shoe kidneys comparable to PCNL in normal kidneys.