Challenging retrograde intrarenal surgery in a pelvic ectopic kidney- an institutional case report and review of literature

Abstract

Retrograde intrarenal surgery (RIRS) has been increasingly used as an effective treatment modality for treatment of stones in anatomically abnormal kidneys. A challenging RIRS in a 27-year-old man, done for a 1 cm calculus in a pelvic ectopic kidney is being presented here in order to highlight the technical difficulties encountered, safety and outcome of RIRS for pelvic ectopic kidneys. A 27-year-old man presented with the chief complaints of left sided flank pain of one year duration. He was discovered to have a left pelvic ectopic kidney 7 years back and later discovered to have a calculus within it 1 year back. He had a history of an attempted rigid ureteroscopy 2 months back at another hospital where they were unable to reach the stone, so they placed a Double J stent over a guidewire. The patient was worked up and taken up for surgery at our institution. Intraoperatively there was a kink at the PUJ, below which the access sheath was placed under C arm guidance and with the flexiscope, the kink was negotiated to reach the stone. Holmium laser was used to disintegrate the stone and DJ stent was placed. Post operatively patient was stable and discharged on day 2. RIRS is a safe and effective modality for the treatment of calculi in pelvic kidneys as seen, technical difficulties like kinks can be overcome by flexiscopy.