To evaluate the effectiveness and safety of current surgical modalities for nephrolithiasis in ectopic pelvic kidneys, a rare congenital anomaly with limited available evidence.
A multicenter retrospective study was conducted across 11 high-volume international centers, including 45 patients with congenital pelvic kidneys who underwent flexible ureteroscopy, multimodal-guided percutaneous nephrolithotomy, and laparoscopic pyelolithotomy. Stone-free rate (defined as 0 mm), need for ancillary procedures, and complications (Clavien-Dindo) were assessed.
Stones were classified as GUYS II in 51.1% of patients and GUYS III-IV in 48.9%. flexible ureteroscopy was the most common primary treatment (51.1%), followed by multimodal guided - PCNL (33.3%). Multimodal-guided PCNL achieved the highest stone free rate (86.7%) and the lowest requirement for ancillary procedures (OR 9.7; 95% CI 1.8-51 compared with other modalities). The overall final stone free rate for the cohort was 65.9% after a mean of 1.38 procedures per patient. Complications occurred in 13.3% of cases, with only one major event (Clavien-Dindo IVa).
Our findings indicate that multimodal-guided PCNL achieved the highest success rates and required fewer ancillary procedures than other approaches when treating stones in ectopic pelvic kidneys. In contrast, flexible ureterorenoscopy showed lower efficacy and required more ancillary interventions. Complication rates were low and comparable to those observed in anatomically normal kidneys. Although larger cohorts would strengthen these observations, the very low incidence of ectopic pelvic kidneys inherently limits the ability to accumulate large patient numbers.
World journal of urology. 2026 Feb 26*** epublish ***
Daniela M Méndez Guerrero, Mehmet Ilker Gökce, Ben H Chew, Esteban Emiliani, Fabio Sepulveda, Janak Desai, Thomas Tailly, Christian Morales, Ignacio Morales, Sung Yong Cho, Adolfo Serrano, Fabio Carvalho Vicentini, Runhan Ren, Cesare Marco Scoffone, Cecilia Maria Cracco, Edgard Efren Lozada Hernandez, Jorge Kazuo Nishimura, Camilo Cortes Alzate, M Sanchez Hector, Braulio Omar Manzo
Endourology Department, Hospital Regional de Alta Especialidad del Bajío, Bvd. Milenio # 130, 37544, Leon, Guanajuato, Mexico., Department of Urology, Ankara University School of Medicine, Ankara, Turkey., Urologic Sciences, University of British Columbia, Vancouver, Canada., Department of Urology, Fundació Puigvert, Barcelona, Spain., Disciplina de Urologia, Universidade Estadual do Sudoeste da Bahia (UESB), Vitória da Conquista, Brazil., Department of Urology, Samved Hospital, Ahmedabad, India., Department of Urology, University Hospital Ghent, Ghent, Belgium., Department of Urology, Hospital Parroquial, Universidad de Los Andes, San Bernardo, Santiago, Chile., Department of Urology, College of Medicine, Seoul National University, SMG-SNU Boramae Medical Center, Seoul, Korea., Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia., Department of Urology, Faculdade de Medicina da Universidade de São Paulo - FMUSP, Hospital das Clínicas, São Paulo, Brazil., Department of Urology, Cottolengo Hospital, Torino, Italy., Clinical Investigation Department, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, México., Endourology Department, Hospital Regional de Alta Especialidad del Bajío, Bvd. Milenio # 130, 37544, Leon, Guanajuato, Mexico. .