Surgical Problems and Results in Horseshoe Kidney

Objective: We aimed to evaluate the clinical features, accompanying surgical problems, and renal development outcomes during nephrological follow-up in patients with horseshoe kidney (HSK). Method: We retrospectively reviewed the medical records of 24 patients with HSK who underwent surgery in our pediatric surgery clinic between 2015 and 2023. Results: Sixteen of the patients were boys and eight were girls. The mean age was 77.3 (1.5-192) months. The mean follow-up period was 48 (12-120) months. HSK was found incidentally in 10 patients and diagnosed prenatally in seven patients. Eleven children had bladder dysfunction and six patients were diagnosed with spina bifida. Thirteen of the patients were found to have frequent urinary tract infections. Anderson-Hynes pyeloplasty for ureteropelvic junction stenosis, ureteroneocystostomy for vesicourethral reflux (VUR) and ureterovesical stricture, vesicourethral injection sting for VUR, upper pole heminephrectomy for nonfunctioning dual system, Holmium laser-guided lithotripsy and unilateral nephrectomy, isthmusectomy and contralateral kidney nephron-sparing surgery were required due to bilateral Wilms tumor. During the postoperative follow-up, three patients continued to have urinary tract infections, five developed renal scarring, three developed proteinuria and four developed hypertension. A total of three patients, including two patients operated for Wilms tumor, had elevated cystatin-C levels and developed chronic kidney disease (CKD). Conclusion: Patients with HSK should be followed up for urologic abnormalities that may require surgery and postoperative urinary tract infection and scar formation in the kidneys. In our study, it was demonstrated that surgical intervention alone cannot prevent CKD.