Cross ectopic multicystic dysplastic kidney with ureterocele in nonectopic site

Crossed renal ectopy (CRE) is the second most common fusion anomaly of the kidney, with an incidence of 1 in 7000 autopsies; it comes in second after horseshoe kidney. Crossed renal ectopy is associated with an ectopic ureter and generally an ectopic kidney fused with a normal kidney. A 7-month-old boy who had left-to-right crossed non-fused renal ectopy and multicystic renal dysplasia with ureterocele in nonectopic kidney was reported in English language literature. In this article, we present the first case of CRE where surgical intervention has been performed.     

Ectopic ureterocele: a case report

A case of ectopic ureterocele is reported. A 2-year-old girl was admitted for recurrent episode of urinary tract infection associated with fever. IVP showed bilateral duplex kidney, although no excretion of dye was noted from the right upper kidney. IVP also revealed a large filling defect at the bladder neck which was diagnosed as ureterocele by cystoscopy. Cystography demonstrated VUR to the right lower kidney. A complete duplication of ureter with ectopic ureterocele on the right, and incomplete duplication of ureter on the left were found at operation. She underwent complete removal of the ectopic ureterocele and reimplantation of the right two ureters. Her postoperative course was uneventful, post-operative IVP revealed improvement of pyelography of the right lower kidney and cystography revealed no VUR.     

Horseshoe kidney with multicystic dysplasia associated with ureterocele

This is a case report of a horseshoe kidney one side of which contains a multicystic dysplastic element associated with a ureterocele. The surgical management and embryologic basis are reviewed.     

Inverted Y duplication of the ureter in association with ureterocele and bladder diverticulum

We report a case of inverted Y duplication of the ureter in association with an obstructing ectopic ureterocele and paraureteral diverticulum. Preoperative radiological studies demonstrated the ureterocele and diverticulum but they failed to show the duplex distal ureter. The duplicated section of ureter was excised and a Cohen reimplantation was performed. The presence of a large ureterocele obstructing the bladder neck, a diverticulum, failure of reflux into the ectopic segment and poor function of the affected kidney all contributed to the difficulties in establishing a preoperative diagnosis.     

Acute retention of urine due to prolapsed ectopic ureterocele in an adult male.

A case is presented of prolapsed ectopic ureterocele which produced severe urinary retention in a 31-year-old male patient. The usefulness of lumbar transcutaneous puncture is emphasized in a case associated with a non-functioning upper pole of a duplex kidney.     

Female wide urethra masquerading as a urethral diverticulum in association with ectopic ureterocele

A rare case of wide urethra in a female infant mimicking as a urethral diverticulum in association with ectopic ureterocele is reported. The ureterocele terminated just below the bladder neck, but the diverticulum-like structure everted from the wide urethra, protruding towards the ureterocele. Weakness of the urethral wall, distal to the actual ureterocele may produce such an abnormal radiologic finding. The pertinent literature is reviewed.     

Unusual anatomic presentation of ectopic ureteroceles

The authors describe four patients with unusual anatomic presentation of ectopic ureteroceles and their surgical treatment. Over a 3-year period, four cases of unusual ectopic ureteroceles were encountered. A 6-month-old girl had a complex cloacal anomaly with an ectopic ureterocele within the cloaca. A 10-year-old boy had two large diverticuli within an ectopic ureterocele combined with a blind-ending ipsilateral ureter. A 3-year-old girl had an ectopic ureterocele combined with a periureteral diverticulum and a completely duplicated ipsilateral kidney. A 4-year-old girl was found to have a vaginal ectopic ureterocele. Despite thorough radiological investigation in all patients, a correct assessment of the anatomic defect was achieved only by surgical exploration or endoscopic evaluation. If preoperative radiological evaluation is equivocal, a high index of suspicion and intraoperative recognition of an unusual anatomic presentation of the ectopic ureterocele are essential for appropriate management and a successful outcome.     

Pancreatic pseudocyst arising from ectopic pancreas and isolated intestinal duplication in mesocolon caused hydronephrosis in a girl with horseshoe kidney

Ectopic pancreas is a relatively common congenital anomaly and is usually asymptomatic. Pancreatitis in the ectopic site and pseudocyst formation is extremely rare. To date, only 2 cases have been reported. We present a case of a 3-year-old girl with recurrent pancreatitis and unilateral hydronephrosis of the horseshoe kidney, which was produced by pancreatic pseudocyst arising from ectopic pancreas and isolated intestinal duplication in mesocolon. This is the first case of pancreatic pseudocyst that expanded to the retroperitoneal space and caused urinary tract obstruction.     

Laparoscopic management of a single system ectopic ureterocele with transitional cell carcinoma in the distal ureter

Single system ectopic ureterocele associated with transitional cell carcinoma in the ureter has not been described previously. Only two cases of transitional cell carcinoma in a single ectopic ureter have been reported in the published literature. With the development of minimally invasive surgery, we report the first case of single system ectopic ureterocele with transitional cell carcinoma in the distal ureter that was successfully managed by laparoscopic surgery.     

Cross-fused ectopic multicystic dysplastic kidney with associated ureterocele

We describe a case of the unique congenital anomaly of cross-fused ectopic multicystic dysplastic kidney with associated ureterocele and demonstrate the usefulness of magnetic resonance imaging in fetal imaging.     

Surgical management of ureteroceles in children: strategy based on the classification of ureteral hiatus and the eversion of ureteroceles

Experience in the surgical management of ureteroceles in children is reported. Six patients with intravesical and 16 with ectopic ureteroceles are included. In the case of intravesical ureterocele of noneverting type. Transurethral distal incision of the ureterocele was performed without reflux. In the case of everting ureterocele, excision with reimplantation of the ureter was performed, thus avoiding reflux inevitably induced by transurethral incision. In the patient with an ectopic ureterocele, a one-stage operation with complete excision of the ureterocele and ureteral stump was attempted. Our choice of operative procedure was decided after the assessment of the following features: cystography and cystoscopy to assess eversion, type of ureteral hiatus (common or separate), whether there was reflux or not to the ipsilateral ureter, and renal function by scintigraphy. Accordingly, hemi-nephroureterectomy or twin ureteroneocystostomy were most commonly performed. When based on these thorough preoperative evaluations, our results were quite favorable.     

A case of renal cell carcinoma in a horseshoe kidney: a case report

A case of renal call carcinoma associated with horseshoe kidney is reported. The patient was a 59-year-old woman complaining of right flank mass. Radiological examination showed right renal tumor and horseshoe kidney, and right nephrectomy was performed. Histological examination showed it to be clear cell type renal cell carcinoma. Only 17 cases of horseshoe kidney with renal cell carcinoma have been reported in Japan. We report the 18th case with a review of the literature.     

输尿管开口异位的外科治疗体会（附51例报告）

目的：总结输尿管开口异位的诊断方法和外科治疗经验,提高对该病的诊疗水平。方法：回顾性分析1997年5月～2012年6月就诊的输尿管开口异位患者51例临床资料,对各种手术方法以及术后情况进行比较讨论。结果：行输尿管膀胱再植术33例,肾输尿管切除术3例,上半重复肾肾输尿管切除术7例,异位输尿管囊肿切除术8例。术后获得随访患者35例,随访时间0．5～8年。仅1例患者仍有尿失禁,但程度较术前明显减轻。1例患者仍有泌尿系感染发作（每年l～2次）,16例输尿管再植患者复查B超患。肾积水较术前减轻。结论：输尿管开口异位多合并有重复集合系统、异位肾脏发育不良、输尿管末端囊肿等上尿路畸形,术前需明确输尿管异位开口部位和相应肾脏功能,据此制定合适的手术治疗方案。     

Ureteroceles]

Four types of ureteroceles are described: A) ureterocele with single ureter (10%); B) ureterocele with total duplication and intra-vesical development (10%); C) ureterocele with total duplication and extra-vesical development (62%); D) ureterocele with ectopic ureter (3%). Most ureteroceles are now detected by antenatal ultrasonography, allowing early management. The treatment of types A and B is simple depending on the status of the above kidney and ureter: abstention, meatomy, ureterocelectomy with ureteral reimplantation, nephrectomy. In type C, the upper kidney is always destroyed. Two treatments are proposed: upper pole nephrectomy with ureterocelectomy which is a difficult but safe procedure, upper pole nephrectomy with aspiration of the ureterocele which is called the "simplified technique" but requires reoperation in 40% cases. The complicated forms may require either meatotomy for decompression, or diversion by percutaneous nephrostomy. Strangulation of the ureterocele constitutes an emergency.     

Renal cell carcinoma in a horseshoe kidney with abdominal aortic aneurysm: a case report

We herein report a case of renal cell carcinoma in a horseshoe kidney with an abdominal aortic aneurysm in a 69-year-old man. Radiological examinations showed a left renal tumor, horseshoe kidney and abdominal aortic aneurysm. We performed a left radical nephrectomy with the division of the isthmus and artificial graft through an abdominal transperitoneal approach. Histological findings revealed clear cell type renal cell carcinoma without invasion of the capsule or renal pelvis. Only 31 cases of renal cell carcinoma in a horseshoe kidney have been reported in Japan, and our case is the 32nd. No case with abdominal aortic aneurysm has been reported previously. We assume that abdominal aortic aneurysm was associated with renal cell carcinoma by chance in the horseshoe kidney in this case. The arterial and venous supplies vary from case to case. We emphasize that arteriography and venography are very important preoperative procedures.     

Endoscopic treatment of ureterocele and antireflux injection with Teflon paste

By referring to two cases, the author demonstrates the possibility of managing certain ureteroceles exclusively by endoscopic treatment. On one hand, by incising or resecting the ureterocele and, on the other hand, by suppressing the reflux thus created with a Teflon injection under the gaping ureterocele. The best indication for this method is the orthotopic ureterocele on a nondivided ureter, i.e. the ureterocele normally found in adults. It also seems possible to treat the orthotopic ureterocele on a duplex kidney in this way. On the contrary, the worst indications for this method are probably ectopic ureteroceles.     

Single ectopic ureter masquerading as ureterocele in incontinent male

A seven-year-old boy with diurnal and nocturnal incontinence was found to have a dysplastic left kidney and an associated ectopic ureter in a single system which opened beside the verumontanum. An intravesical bulge was identified which resembled a ureterocele but was, in fact, a dilated ectatic lower ureter proximal to the orifice of the ectopic opening bulging posteriorly into the bladder. This bulge masqueraded as a ureterocele.     

Obstructive ureterocele—an ongoing challenge

Ureterocele is a cystic dilatation of the intravesical ureter that is most commonly observed in females and children, and usually affects the upper moiety of a complete pyeloureteral duplication. According to their position, ureteroceles are divided into intravesical, when the ureterocele is completely contained inside the bladder, and extravesical when part of the cyst extends to the urethra or bladder neck. Most ureteroceles are diagnosed in utero or immediately after birth during an echographic screening of renal malformations. Severe, febrile urinary tract infection is the most common postnatal presentation of ureteroceles, but they may, rarely, prolapse and acutely obstruct the bladder outlet. Once an ureterocele is identified sonographically, a voiding cystourethrogram to detect vesicoureteral reflux (VUR) and a 99m-technetium dimercapto-succinic acid renal scan to evaluate the function of the different portions of the kidney are mandatory. VUR in the lower pole is observed in 50% of cases and in the contralateral kidney in 25%. Simple endoscopic puncture of the ureterocele has recently been advocated as an emergency therapy for infected or obstructing ureteroceles and as an elective therapy for intravesical ureteroceles. The rate of additional surgery after elective endoscopic puncture of an orthotopic ureterocele ranges from 7 to 23%. Treatment of ectopic ureteroceles is more challenging and both endoscopic puncture and upper pole partial nephrectomy frequently require additional surgery at the bladder level. The reoperation rate after endoscopic treatment varies from 48 to 100%. It is 15 to 20% after upper pole partial nephrectomy if VUR was absent before the operation, but is as high as 50–100% when VUR was present. Thus, endoscopic incision is appropriate as an emergency treatment or when dealing with a completely intravesical ureterocele. Upper pole partial nephrectomy is the elective treatment for an ectopic ureterocele without preoperative VUR. In an ectopic ureterocele with VUR, no matter which type of primary therapy has been chosen, a secondary procedure at the bladder level, involving ureterocele removal and reimplantation of the ureter(s), should be anticipated.     

Noncrossed renal ectopia with fusion associated with single ectopic ureterocele

We report a case of noncrossed renal ectopia with fusion associated with a single ectopic ureterocele. This association is rare, and it is extremely rare that an ectopic ureterocele is not a part of the duplicated urinary collecting system. Some problems about classification of renal fusion and ectopia are presented, and a new classification is introduced.     

A case of inverted Y ureteral duplication with an ectopic ureterocele]

A 29 year-old male with the complaints of two steps urination and sense of residual urine was admitted. At cystoscopy, a ureterocele was found between the normal left ureteric orifice and the bladder neck. Excretory urography demonstrated a radiolucent area in the bladder and a left lower hydroureter. Retrograde pyelography revealed that the left ureter was divided into two branches. Operative exploration demonstrated that the left ureter was an inverted Y ureteral duplication with an ectopic ureterocele; one opened into the ureterocele and the other into the trigone. We resected the ureterocele wall. Four months later, a voiding cystogram did not show vesicoureteric reflux. Now, he has no symptoms and the results of examination are normal. An inverted Y ureteral duplication is the rarest of all anomalies of the ureter. A review of the literature revealed 36 cases reported previously. Clinical analysis was obtained by reviewing 26 of these cases and adding our own (male 10: female 17, average age: 23 years). Complication included 6 cases of ectopic ureteral opening, 6 with blind-ending branch and 5 with ureterocele. The symptoms of this disease depended on the complicating anomalies. The present case was the 5th one of an inverted Y ureteral duplication with a ureterocele in the world literature.