Against the Odds: Management of Ureteral Calculus in Patient With Crossed Fused Renal Ectopia.

Jasmina Heljić,Zahid Lepara,Senad Bajramović,Jasmin Alić,Hajrudin Spahović

doi:10.7759/cureus.10895

Abstract

Crossed fused renal ectopia (CFRE) is a rare congenital abnormality of the urinary tract where the kidneys are fused on one side, while the ureter of the ectopic kidney crosses the midline with the normal entrance in the bladder on the contralateral side. Congenital anomalies are associated with a stone formation whose management represents a real challenge. To our knowledge, we report the second case of CFRE associated with ureteral stone, which has been successfully resolved with Extracorporeal Shockwave Lithotripsy (ESWL) and the first of its kind where a sufficient degree of stone disintegration has been achieved after a single session with a complete stone clearance during the follow-up. Radiological examination showed an inferior type of CFRE with stone in the proximal part of the ureter of the upper kidney. ESWL is an acceptable and effective treatment option in CFRE patients due to the minimally invasive approach, potentially high stone-free rate, and rare complications.

Highlights

Crossed fused renal ectopia (CFRE) is a rare congenital abnormality of the urinary tract where the kidneys are fused on one side, while the ureter of the ectopic kidney crosses the midline with the normal entrance in the bladder on the contralateral side
We report the second case of CFRE associated with ureteral stone, which has been successfully resolved with Extracorporeal Shockwave Lithotripsy (ESWL) and the first of its kind where a sufficient degree of stone disintegration has been achieved after a single session with a complete stone clearance during the follow-up
Crossed fused renal ectopia (CFRE) is a rare congenital abnormality of the urinary tract where one of the kidneys is located on the opposite side of its vesicoureteral junction, fused to the ipsilateral kidney

Summary

Introduction

Crossed fused renal ectopia (CFRE) is a rare congenital abnormality of the urinary tract where one of the kidneys is located on the opposite side of its vesicoureteral junction, fused to the ipsilateral kidney. Most individuals have no symptoms in absence of infection and/or urolithiasis, CFRE is often incidentally detected It is associated with an increased rate of stone formation, and with skeletal, cardiovascular, genitourinary, and gastrointestinal abnormalities [2]. A case of ureteral calculus in a patient with CFRE successfully treated with only one session of Extracorporeal Shockwave Lithotripsy (ESWL) is presented in this report. A 53-year-old man presented with intermittent abdominal pain projecting into the left lumbar region. CECT scan showed inferior CFRE with stone at 3 centimeters distal to the ureteropelvic junction of the upper (left) kidney (Figure 1). The average stone density measured by CT was 1090 Hounsfield units (HU) Both upper and lower kidney had one renal artery originating from the unusual place on the aorta at the level of the superior mesenteric artery and aortic bifurcation (Figure 1A). The patient stayed asymptomatic with no dilatation of the renal collecting systems detected by abdominal ultrasonography

Discussion

Conclusions

Disclosures

Kretschmer HL