Open Access

ARTICLE

Malignancy in horseshoe kidneys: review and discussion of surgical implications

L. Fazio, H. Razvi, J. L. Chin

Department of Urology, University of Western Ontario, London, Ontario, Canada
Address correspondence to Hassan Razvi, MD, St. Joseph’s Health Centre, 268 Grosvenor Street, London, Ontario N6A 4V2 Canada

Canadian Journal of Urology 2003, 10(3), 1899-1904.

Abstract

Objective: Horseshoe kidney is one of the most common congenital anomalies of renal structure. Not infrequently, surgical management of both benign and malignant disorders is required in patients with horseshoe kidney due to the susceptibility to certain conditions. The literature suggests a greater proclivity to certain renal tumors with this anomaly. We present three cases of malignancy in horseshoe kidneys. The unique technical challenges presented by these cases and the surgical approaches are discussed.
Methods: Three patients with tumors involving horseshoe kidneys are reviewed and their management discussed.
Results: Two patients were found to have renal cell carcinoma (RCC) and one had transitional carcinoma (TCC). Computed tomography (CT) and angiography were used in the work-up and preoperative planning of these cases. One patient with RCC received preoperative renal artery embolization. Partial nephrectomy was performed in each patient with an aim at early vascular control of the tumors, identification of the collecting systems and ureters, as well as ensuring a 1 cm surgical margin. No patient required dialysis postoperatively. One patient died in the early postoperative period of a myocardial infarction; one patient developed brain metastases 18 months postoperatively, received palliative radiation and is alive 42 months after surgery; the other patient was free of disease for approximately 36 months but recently developed osseous metastases to her pelvis.
Conclusions: Techniques developed for partial nephrectomy may be used in the treatment of tumors in horseshoe kidneys. Survival is related to the grade and stage of disease.

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