Laparoscopic Pyelolithotomy for Recurrent Stone in Previously Operated Ectopic Pelvic Kidney

Abstract

An ectopic kidney is a rare congenital anomaly that has been associated with complications as reflux, hydronephrosis, nephrolithiasis, and sometimes renal failure. Calculous diseases in the pelvic kidney due to their anatomical characteristics pose a significant challenge to the surgeon. We herein report a case of transperitoneal laparoscopic pyelolithotomy for treatment of renal pelvis stone in an ectopic pelvic kidney who had already undergone open pyelolithotomy in past. A 34 years old man presented to our hospital with pain abdomen for five months and a history of left open pyelolithotomy done almost eleven years back. Computed tomography scan revealed severe hydronephrosis and 3.5 cm calculus in the pelvis of ectopic malrotated left kidney. The patient underwent left laparoscopic pyelolithotomy, complete stone clearance was achieved, 20 fr drain was placed with no DJ (Double J) stent. For two consecutive days there was significant drain output, subsequently cystoscopy with DJ stenting was done then drain output was reduced. On fifth postoperative day the drain was removed and he was discharged. In a patient with a malrotated pelvic kidney with recurrent stone and past surgery, proper pre-operative evaluation & the selection of the most appropriate surgical technique play a crucial role to get the best surgical outcome. Keywords: Ectopic kidney, laparoscopy, pyelolithotomy, renal pelvic calculous.