HORSESHOE KIDNEY WITH BILATERAL SINGLE SYSTEM ECTOPIC URETERS

A horseshoe kidney, associated with bilateral single system ectopic ureters in a 9-month-old boy, is reported. The right ureteric orifice was located near the midline of a deformed trigone while the grossly dilated left ureter inserted into the posterior urethra. Imaging defined this rare combination of urological anomalies prior to surgical treatment.     

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.     

一种交叉异位融合肾新亚型及其诊治

目的:观察一种交叉异位融合肾新亚型的发病情况,探讨其临床分型、诊断与治疗以及发病机制。方法:回顾性分析1例交叉异位融合肾合并髂血管后巨输尿管异位开口和胸椎侧弯患者的临床资料,包括患者的病史资料、影像资料和手术探查交叉异位融合肾的术中所见,然后进行文献复习。结果:文献复习证实这可能是交叉异位融合肾的一种新亚型,交叉异位融合肾合并髂血管后异位输尿管在以前的文献中也从未见报道,患者的异位输尿结石并感染通过手术治愈。结论:男性的异位输尿管开口更为隐蔽,需要联合多种方法进行诊断。     

A male patient with right-sided thoracic kidney,diabetes mellitus,hearing loss and renal dysfunction

A 48-year-old man with diabetes mellitus and hypertension was found to have a thoracic right-sided ectopic kidney with a sensorineuronal hearing loss and tubular abnormalities such as hyponatremia, hypokalemia, metabolic alkalosis with microalbuminuria. He was treated with ACEI and sodium and potassium supplements. However, this only partially corrected his metabolic abnormalities.     

Right thoracic kidney with simple renal cyst: report of a case

A case of right thoracic kidney with simple renal cyst is reported. A 67-year-old man was pointed out to have an abnormal shadow in the right lower lung field of chest X-ray film. He was asymptomatic. Laboratory test was normal. Computed tomography and excretory urography confirmed the right thoracic kidney with a simple cyst. Adrenal scintigraphy revealed a high ectopic adrenal gland with right thoracic kidney. Since he was asymptomatic, treatment was not required. High ectopic kidney is extremely rare and 74 cases have been reported in the domestic literature in Japan. Thoracic kidney should be considered as one of differential diagnoses of abnormal mediastinal shadow.     

Living-related transplantation of an ectopic pelvic kidney

Ectopic kidneys are usually contraindicated for transplantation as a result of anomalous vascular and drainage system. Graft shortage increases the need of expanding the donor pool and the use of ectopic pelvic kidneys might provide a small but useful source. Transplantation of an ectopic pelvic kidney is a technically demanding procedure and very few cases have been published. We present a case of a living-related kidney transplantation of an ectopic pelvic kidney. The donor was a healthy 65-year-old lady and preoperative work-up had showed a left ectopic pelvic kidney. The recipient was a 34-year-old male with a history of end-stage renal disease secondary to chronic glomerulonephritis. After the transplantation, there was an immediate function of the allograft and the donor's postoperative course was uneventful. The donor was discharged on the fifth postoperative day.     

Ureteropelvic junction obstruction in a thoracic kidney treated by dismembered pyeloplasty

Ectopic positioning of the kidney is a relatively common event, with the thoracic location of the ectopic kidney the most unusual. At least 140 cases of thoracic kidney have been described, with no consistent anomalies reported in association with the superior location. The vast majority of patients with thoracic kidney are asymptomatic, with the problem discovered incidentally. We report the first documented case of a thoracic kidney presenting with flank pain and demonstrating ureteropelvic junction obstruction on nuclear scintigraphy treated by open dismembered pyeloplasty through a supra-11th rib incision.     

腹腔镜切除先天性盆腔异位肾一例报告并文献复习

目的探讨盆腔异位肾的影像学诊断及腹腔镜技术在其治疗中的价值。方法对1例盆腔异位肾患者采用腹腔镜异位肾切除,结合文献复习讨论盆腔异位肾的诊治措施。结果B超与螺旋CT均示左肾区未见正常肾脏影像,于盆腔内发现先天性左侧盆腔异位肾伴旋转发育不良及重度肾积水。腹腔镜异位肾切除手术时间100 min,患者术中无输血,术后第3天拔除引流管并开始下床活动,术后第4天出院。随访2个月,下腹部症状消失,肾功能正常。结论确诊盆腔异位发育不良肾,尤其合并重复肾盂和输尿管或异位血管压迫等并发症时,B超和多层螺旋CT应是最佳诊断组合。腹腔镜因视野清晰,出血少、创伤小、手术时间短,术后住院时间明显降低,在盆腔异位肾的治疗术式选择中占有重要地位。     

Laparoscopic pyelolithotomy – A technique for the management of stones in the ectopic pelvic kidney

We present our preliminary experience with the technique of laparoscopic pyelolithotomy for ectopic pelvic kidney calculi. This surgery has low morbidity and is ideally suited for the ectopic pelvic kidney with a laterally or anteriorly directed pelvis.     

Direct pelvic access percutaneous nephrolithotomy in management of ectopic kidney stone: a case report and literature review

Abstract

Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7?×?1.7?cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5?cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.     

ECTOPIC URETER AS A CAUSE OF WETTING: THE ROLE OF LAPAROSCOPY IN ITS MANAGEMENT

A diagnosis of wetting caused by an ectopic ureter usually can be made from the history because of the characteristic pattern of wetting. Localization of the origin of the ectopic ureter is important in guiding the surgical approach. This is usually not a problem for cases of ectopic ureter arising from a duplex system. However, the single ectopic ureter arising from a small dysplastic and often ectopic kidney may defy a long search. Videolaparoscopy, with its magnifying effect, can confirm the diagnosis, localize the dysplastic kidney and allow its removal using endoscopic equipment.     

Ectopic Ureterocele with a Horseshoe Kidney in an Adult

A rare adult case of a left ectopic ureterocele associated with a duplex horseshoe kidney is reported. To the best of our knowledge, only one pediatric case of horseshoe kidney with an ectopic ureterocele has been reported. The present case was successfully treated by ureteropyelostomy, upper ureterectomy and unroofing of the ureterocele. The patient is currently followed with excretory urograms and renograms.     

The risk of associated urological abnormalities in children with pre and postnatal occasional diagnosis of solitary,small or ectopic kidney: is a complete urological screening always necessary?

OBJECTIVE: Voiding cystourethrogram (VCUG) and radionuclide scan is recommended for patients with solitary (secondary to aplasia or multicystic dysplasia), hypoplasic or single ectopic kidney, to detect associated anomalies (vesicoureteric reflux, obstructive uropathies). With the increase of occasional diagnosis, mainly by fetal ultrasound (US), the possibility of an unjustified extension of diagnostic work up must be prevented. Aim of this paper was to estimate the incidence of associated anomalies in asymptomatic cases without associated US signs of hydronephrosis. MATERIALS AND METHODS: Among 158 Patients examined there were 81 solitary kidneys (26 multicystic dysplasia), 27 small kidneys, 50 single ectopic kidneys); prenatal diagnosis was recorded in 86%. Incidence of associated anomalies was compared with figures resulting when symptomatic cases or with hydronephrosis were excluded. RESULTS: Vesicoureteral reflux or obstruction were found in 17% of solitary kidneys, 70% of hypoplasic kidneys and 2% of single ectopic kidneys. Among those (120 cases) without infection or hydronephrosis, incidence decreased, respectively to 5, 60 and 0%. CONCLUSIONS: Associated anomalies are reported to affect up to 48% of solitary kidneys and about 30% of single ectopic; 80% of severe reflux are usually associated to small kidneys. In our series of solitary and ectopic kidneys incidence of abnormalities was significantly less and fell to negligible values when occasionally detected, undilated cases were considered. On this basis, indiscriminate urological screening simply based on the occasional pre or postnatal detection of undilated solitary or ectopic kidney appears to be unjustified. Small kidneys deserve special attention and VCUG is always indicated.     

Retroperitoneal Laparoscopic Pyelolithotomy in an Ectopic Pelvic Kidney

Background and Objectives:

Retroperitoneal laparoscopic pyelolithotomy was performed in an ectopic pelvic kidney with renal pelvis calculi.

Methods and Results:

Laparoscopic pyelolithotomy was successfully performed in an ectopic pelvic kidney by using the retroperitoneal route. The total operation time was 130 minutes, and the estimated blood loss was <50mL. The patient was discharged on the second postoperative day without any complications.

Conclusion:

Laparoscopic pyelolithotomy is an effective treatment option for management of stones in the pelvis of an ectopic pelvic kidney. The retroperitoneal route may help to avoid intraoperative and postoperative complications.     

Laparoscopic assisted percutaneous nephrolithotomy in ectopic pelvic kidneys

Abstract:   Three patients underwent laparoscopic assisted percutaneous nephrolithotomy (PNL). A kidneys, ureter and bladder (KUB), and intravenous pyelogram (IVP) of the first patient showed a 3 cm calculus in a right side ectopic pelvic kidney overlying on the sacrum. The second patient had bilateral ectopic kidneys. The right kidney was located in the true pelvis without calculi and the left kidney was located in the iliac cavity with a 2.5 cm calculus in the renal pelvis. The third one had a 4 cm stone in the infundibulum of the upper calyx of the left pelvic ectopic kidney. All of them had a history of failed shock wave lithotripsy after two sessions.
Then the patients were scheduled for laparoscopic assisted percutaneous removal of calculi. Under fluoroscopic control the best access route was located and the kidney was punctured. A 24F nephroscope was introduced and all calculi were disintegrated and removed. Operating time was 150, 120 and 110 min in cases 1, 2 and 3, respectively. Complete stone clearance was documented with a plain X-ray KUB film and ultrasonography.
Finally the patients underwent IVP three months following the operation. They were all well and there were no early or late complications.     

Hydronéphrose géante sur rein ectopique pelvien révélée par un syndrome occlusif: Cas rare.

Giant hydronephrosis in an ectopic pelvic kidney is an exceptional finding. Only five cases have been published in the literature. Hydronephrotic ectopic kidney can cause extrinsic compression of adjacent structures.Herein, we report a case of giant hydronephrosis of ectopic left pelvic kidney, in a 17-year-old patient, diagnosed by acute intestinal obstruction. Primary management consisted of ultrasound guided percutaneous nephrostomy to relieve the obstruction. Then definitive treatment consisted of a left retroperitoneal nephrectomy through a pelvi-abdominal approach. Surgical exploration has highlighted a double renal pedicle, from a primitive iliac artery and another branch from the internal iliac artery. The resulting pedicle of the latter, formed a vascular tie around the renal pelvis causing the hydronephrosis     

Laparoscopic transmesocolic pyelolithotomy in an ectopic pelvic kidney.

Management of large calculi in ectopic pelvic kidneys poses a challenge to the urologist. Risk of injury to surrounding abdominal viscera and vasculature makes open surgery as well as percutaneous nephrostolithotomy in an ectopic kidney a challenging procedure. Laparoscopic management avoids open surgery and associated morbidity and offers added safety. We report the management of symptomatic stones in a pelvic ectopic kidney lying anterior to the L5 vertebra and sacrum by transmesocolic laparoscopic pyelolithotomy in an 11-year-old child. Complete stone clearance was achieved with no complications and an uneventful postoperative recovery. The patient was discharged 72 hours after the surgery.     

Laparoscopic nephrectomy for a single-system ectopic ureter draining a small, dysplastic and poorly functioning kidney in children

PURPOSES: To assess the efficacy of laparoscopic nephrectomy for a single-system ectopic ureter draining a dysplastic kidney in children. PATIENTS AND METHODS: Between February 1999 and September 2005, 16 girls with a mean age of 6.2 years (range: 2-15 years) presented with urinary incontinence accompanied by regular voiding since birth (15 patients) and vaginitis (one patient). Ultrasonography, intravenous urography and a 99mTc-DMSA renal scan showed the presence of only a single kidney in all cases. Computed tomography (CT) showed a dysplastic kidney definitely in nine patients, structures suspicious of dysplastic kidney in three cases, and no dysplastic kidney in four cases. Magnetic resonance imaging was carried out in the four cases with non-visualized dysplastic kidneys by CT, and showed a suspicious lesion in only one case, and no lesion in the other three patients. All patients underwent transperitoneal laparoscopic nephrectomy for a dysplastic kidney. RESULTS: Laparoscopy identifies all dysplastic kidneys easily, even in those cases in which dystrophic kidney could not be identified by preoperative imaging. Dysplastic kidneys and ectopic ureters were removed successfully in all 16 patients. Mean operative time was 109 min (range: 40-155 min) with little intraoperative bleeding. Mean postoperative hospital stay was 2.6 days (range: 2-4 days). No intraoperative complication was encountered, except in one single case, in which a small bowel injury occurred during open Hasson's procedure. All patients became dry soon after the operation. CONCLUSION: Laparoscopic nephrectomy for an ectopic ureter draining into a dysplastic kidney is a safe and effective method, and can be carried out successfully, despite a failure by preoperative imaging studies to localize the dysplastic kidney.