Abstract
Background: A horseshoe kidney is the most common renal fusion anomaly and occurs in 0.2% to 0.3% of the population. Horseshoe kidneys are fused by the formation of an isthmus between the lower poles of the left and right kidneys during development. The insertion of the ureter in the renal pelvis is displaced super-laterally, probably as the result of incomplete renal rotation, and is associated with a significant rate of ureteropelvic junction (UPJ) obstruction. Case Presentation: We report a patient with single kidney at right side with obstruction in upper ureter. Before the surgery our plan was transureteroureterostomy according to failure of previous surgeries, dismembered pyeloplasty and ureterocalicostomy, but after mobilizing the proximal ureter we noticed that transureteroureterostomy was impossible because of short fibrotic ureter. Other choices such as Boari flap technique with psoas hitch is impossible because of small fibrotic bladder, so we decided to use appendix as ureter substitute. Conclusions: According to our experience and previous studies, we can use appendix as a ureter substitution in refractory proximal and middle ureter stenosis, but in our case we anatomized proximal ureter to appendix instead of anastomosis of pelvic to appendix.
Highlights
A horseshoe kidney is the most common renal fusion anomaly and occurs in 0.2% to 0.3% of the population
Before the surgery our plan was transureteroureterostomy according to failure of previous surgeries, dismembered pyeloplasty and ureterocalicostomy, but after mobilizing the proximal ureter we noticed that transureteroureterostomy was impossible because of short fibrotic ureter
Horseshoe kidneys are fused by the formation of an isthmus between the lower poles of the left and right kidneys during development .The insertion of the ureter in the renal pelvis is displaced super-laterally, probably as the result of incomplete renal rotation, and is associated with a significant rate of ureteropelvic junction (UPJ) obstruction [2]
Summary
A horseshoe kidney is the most common renal fusion anomaly and occurs in 0.2% to 0.3% of the population [1]. In review of familial history of the patient, both of mother and father had nephrolithiasis and his sister suffered from end-stage renal failure (ESRD). He referred to our clinic for recurrent right ureteral stricture stenosis after dismembered pyeloplasty and ureterocalicostomy, and frequent stent insertion , According to imaging studies proximal ureter stenosis observed in this patient. The results of imaging were including renal ultrasonography that showed right kidney with severe hydronephrosis (Figure 1), length was 13.4cm, parenchyma was around 2 cm and the length of left small kidney was 4 cm. Dimercaptosuccinic acid (DMSA) scan showed right kidney hydronephrosis and left kidney without function. Imaging studies including EC Scan were done 1 month and 6 month after stent removal results were ruled out the obstruction
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