Report of ectopic kidney in thorax with bilateral vesicular uretral reflux

Introduction : The incidence of ectopic kidney in autopsy series is around 1 in 900 otherwise it is 1 in 3000. There are various treatment modalities that can be utilised to treat these renal calculi e.g., extracorporeal shock wave lithotripsy, laproscopy assisted per-cutaneous nephrolithotomy, retrograde intra-renal surgery using the flexible ureteroscope, laproscopic/robotic pyelolithotomy and open surgery. We here describe a case of RIRS for stone in the pelvis of ectopic left kidney located on the right side just below the right kidney, it was crossed but not fused. To the best of our knowledge, this is first such case to be reported in crossed non-fused ectopic kidney. Case Report : A 33 years young male came with complaints of intermittent pain right loin for 2-3 months, mild initially but severe for last 24 hours. Physical examination suggested mild tenderness right iliac fossa. Ultrasonography and intravenous pyelography suggested ectopic left kidney located on right side below the right kidney in the right iliac fossa and not fused or attached to the right kidney with a large 21mm pelvic calculus with mild hydronephrosis. He later underwent retrograde intra-renal surgery where stone was completely lased and double J stent was kept at the end of the procedure. Results : Complete stone clearance was confirmed visually and under c-arm. Post operative USG and x-ray KUB showed no residual calculus. Patient was discharged on second postop day. There were no post-op complications. The double J stent was removed after two weeks. Conclusion : RIRS is a very good option to treat stones in an ectopic kidney. It may require more than one session sometimes, but considering the minimal invasive nature, the bothersome is less. Disposable ureteroscopes have further revolutionised the armamentarium of the urologist, who can now offer a personalised treatment plan for each patient. Keywords : RIRS, ectopic kidney, crossed ectopic non-fused kidney, stone in ectopic kidney, minimal invasive laser surgery

Objective To compare and analyze the difference of measured glomerular filtration rate (GFR) of ectopic pelvic kidney between anterior and posterior imaging processing in renal dynamic imaging.Methods There were 10 patients collected retrospectively,with ectopic kidneys in pelvic cavity confirmed by ultrasound,CT,renal dynamic imaging and other imaging modalities.All images of ectopic kidneys in renal dynamic imaging were processed by anterior and posterior methods respectively.The ectopic kidney was only processed in anterior imaging,ectopic kidney and contralateral normal kidney were processed in posterior imaging.Total GFR equalled the sum of GFR of normal kidney in posterior imaging and GFR of ectopic kidney in anterior imaging,was compared with total GFR of two kidneys in posterior imaging and GFR in two-sample method.All correlation analysis were completed between GFRs from three methods and all patients were followed up.Statistically paired t-test and bivariate correlation analysis test were used.Results The mean GFR of ectopic kidney in anterior imaging equal to (27.48±12.24) ml/(min· 1.73 m2).It was more than GFR [(10.71 ±4.74) ml/ (min· 1.73 m2)] in posterior imaging above 46％ (t=5.481,P＜0.01).There was no significant difference (t=-2.238,P＞0.05),but better correlation (r=0.704,P＜0.05)between total GFR in anterior imaging and GFR in two-sample method.There was significant difference (t=4.629,P＜0.01)and worse correlation(r=0.576,P＞0.05)between total GFR in posterior imaging and GFR in two-sample method.Conclusion Comparing with GFR in posterior imaging,GFR in anterior imaging can more truly reflect function condition of ectopic pelvic kidney in renal dynamic imaging. Key words: Glomerular filtration rate ; Ectopic kidney ; Renal dynamic imaging

V6-02 ROBOTIC PYELOLITHOTOMY IN ECTOPIC PELVIC KIDNEY: SIDE DOCKING IN SUPINE POSITION AND A FOUR-ARM APPROACH

Introduction and importanceCrossed fused renal ectopia is a rare congenital condition that might pose some diagnostic and therapeutic challenges to clinicians. We report a patient with a non-functional crossed fused ectopic left kidney that obstructed the orthotopic kidney in a rarely observed situation.Case presentationA 68-year-old male presented a right flank pain with fever. The diagnosis of right obstructive pyelonephritis was dressed, after biological and radiological investigations. The obstacle was a crossed ectopic left kidney in its inferior variety. The ectopic kidney was non-functional as result of an obstructive ureteral calculus. The patient had right ureteral stenting with a double-J catheter. Three months later, left nephrectomy was performed by lumbotomy. Per operative difficulties were mainly the infiltration of peri renal fat, the anarchic vascularization and the multiple small pedicles of the ectopic kidney that was also malrotated with the hilum facing anteriorly. Postoperative recovery was uneventful and the patient left the hospital after three days.Clinical discussionCrossed Fused renal ectopy is rare. As shown in this case, the ectopic kidney might cause damage to the orthotopic kidney, by compression to urinary ducts. Surgery is the main treatment option. Some difficulties related to aberrant vascularization and possible malrotation is to preview.ConclusionCrossed fused renal ectopia is uncommon renal anomaly, mostly asymptomatic. However, it may be responsible of some complications, sometimes severe. Surgery can be delicate due to vascular complexity.

Ectopic kidneys though uncommon can be associated with other anomalies of the genitourinary system such as uretero-pelvic junction obstruction, vesicoureteral reflux and upper urinary tract abnormalities. These associations present surgical challenges in an ectopic kidney. We report the surgical management of a right ectopic kidney associated with uretero-pelvic junction obstruction and severe hydronephrosis. A 27-year-old male presented to Zenith Medical and Kidney Center in Abuja with complaints of recurrent, dull right flank pain of 1 year duration. Physical examination revealed a non-tender cystic mass extending from the right iliac fossa to the right hypochondrium. Abdominopelvic computed tomography revealed huge intraperitoneal non-enhancing hypodense ovoid cystic mass difficult to differentiate from the right ureter with severe intraperitoneal mass effect. Retrograde pyelogram done revealed right ectopic pelvic kidney with uretero-pelvic junction obstruction. The patient subsequently had right open Anderson-Hynes pyeloplasty. Intraoperative findings were right ectopic pelvic kidney with uretero-pelvic junction obstruction secondary to intrinsic narrowing at the junction and severe hydronephrosis. Posto­perative recovery was uneventful with complete resolution of the presenting symptom. Ectopic kidneys can be associated with uretero-pelvic junction obstruction which presents diagnostic and surgical treatment challenges. Retrograde pyelography is an important radiological armamentarium for the proper diagnosis and subsequent treatment of this condition.

BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disorder and the fourth cause of death of end-stage renal disease. The disease has a prevalence of 1:400–1:1000 accounting for 10% of patients on dialysis. In most ADPKD patients, bilateral kidneys are similarly affected, with numerous fluid-filled cysts arising from different nephron segments. Only a few cases of ADPKD with ectopic unilateral multicystic kidney have been reported. It has been observed that the deterioration of their kidney function seemed to be quicker than their age- and sex-matched controls and siblings especially when the ectopic kidney is dysplastic.Case presentationWe report a case of a 46-year-old Ghanaian male patient who presented with left flank pain and hematuria with high BP and deranged renal function. Abdominal ultrasonography showed both kidneys to be larger than normal and had multiple cysts of varying sizes with the right kidney located in the right iliac fossa. Follow up Abdominopelvic computer tomographic scan (CT–Scan) without contrast showed enlarged kidneys with the renal parenchyma replaced by innumerable cyst of varying sizes. The right kidney was ectopically located in the right aspect of the pelvis. A diagnosis of ADPKD with right pelvic ectopic multicystic kidney was made. He was put on antihypertensives, analgesia for the left flank pain and to have follow up at the urology and nephrology departments.ConclusionIn most ADPKD patients, bilateral kidneys are similarly affected. Only a few cases of ADPKD with ectopic unilateral multicystic kidney have been reported. It has been observed that the deterioration of their kidney function seemed to be quicker than their age- and sex-matched controls and siblings especially when the ectopic kidney is dysplastic.

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.

Anomalous kidneys are mostly asymptomatic and are often found incidentally during physical or radiological investigations for urological or other medical complaints. The associated genital anomalies ranges from 15% to 45%. Females are associated with bicornuate or unicornuate uterus, rudimentary or absent uterus while males have undescended testes, duplication of the urethra, and hypospadias. A 21 year old married female presented with on and off lower abdomen pain for the past one year with history of primary amenorrhea. On examination an ill defined tender lump palpated in the lower abdomen. USG showed left ectopic pelvic kidney with gross hydronephrosis. The computed tomography confirmed hydronephrotic left ectopic pelvic kidney in front of the sacrum with anteriorly directed renal pelvis with ureter located posteriorly. There was delayed excretion from the ectopic kidney but right kidney was in normal position and function. The diethylene triamine pentaacetic acid (DTPA) scan showed 33% function of the ectopic kidney. On diagnostic laparoscopy, the uterus was small hypoplastic with bilateral ovaries appearing normal. The patient was taken for open pyeloplasty where the ureter was transected below PUJ but for a dependent drainage, the middle calyx as was the most dependent calyx as seen on the CT-scan. So a middle calyx ureterocalicostomy was performed calyx with excellent outcome. The ectopic kidney always remains a challenge because of complex neurovascular anatomy, presence of viscera and associated UPJO, but for a dependent drainage, middle calyx ureterocalicostomy is a feasible option with excellent outcome as was in our case.

Ectopic kidney is a congenital malformation which is very rare. The most frequent localisation is in the pelvis. Ectopic kidney is frequently diagnosed incidentally during radiological examination. Because it creates pelvic mass, it can be misdiagnosed as colonic tumours or ureteric masses. In September 2011, a 45-year-old male patient, applied to the emergency service with abdominal pain. On physical examination, there was a left pelvic mass, and left inguinal and left costovertebral sensitivity. In microscopic evaulation of urine, erythrocytes were abundant and the leukocyte value was 3/hpf. Abdominal-pelvic ultrasonography and computed tomography examinations were performed and the patient was diagnosed with an ectopic pelvic kidney and a left ureteral stone. Ureteral stones resulting from an ectopic pelvic kidney are not common. In patients who have applied to the emergency service with abdominal pain, pelvic mass and with no accompanying pathology, a ureteral stone as a result of an ectopic pelvic kidney may be considered as not requiring treatment.

Purpose:Patients with deranged renal functions have a number of associated factors which can impair healing of wound and increase postoperative morbidity. This study was conducted to assess the problems while managing ectopic pelvic kidney calculi using laparoscopic approach for percutaneous nephrolithotomy (PCNL) in chronic kidney disease patients.Subjects and Methods:Patients with calculi in ectopic kidney with increased serum creatinine level secondary to obstruction were included in the study. Initially, obstruction was relieved. Patients later underwent laparoscopic-assisted PCNL. Patients were monitored postoperatively.Results:Three patients with large renal calculi in ectopic pelvic kidney had presented in 2 years. Laparoscopic-assisted PCNL was done to remove the stone. Patients had persistent urine leak post-operatively. Mean duration for removal of nephrostomy tube and drain removal were 4.67 days and 6.67 days, respectively. These patients also had paralytic ileus for prolonged duration.Conclusion:Although laparoscopic assisted PCNL is an option in the management of patients with stone disease in ectopic pelvic kidney, prolonged time for healing of tract may increase postoperative morbidity in these patients with impaired renal function.

An ectopic kidney is a rare congenital defect in which the kidney does not migrate to its normal anatomical position. In the present study, a robot-assisted radical cystectomy and intracorporeal urinary diversion were performed for a patient with an ectopic kidney. The present study describes the case of a 72-year-old male patient who was diagnosed with a bladder tumor by magnetic resonance imaging and cystoscopy. A transurethral resection of the bladder tumor was performed. The pathological examination revealed an invasive urothelial carcinoma. Contrast-enhanced computed tomography revealed an ectopic left kidney in the upper pelvis. A robot-assisted radical cystectomy, extended lymph node dissection and intracorporeal urinary diversion were performed. On the whole, as demonstrated herein, a robot-assisted radical cystectomy with intracorporeal urinary diversion is a feasible approach for muscle-invasive bladder cancer complicated by an ectopic 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.

An ectopic kidney is often found inadvertently during CT, ultrasonography, MRI, or urologic physical examination. Ectopic kidneys usually occur in the pelvis. A pelvic ectopic kidney may be misinterpreted for a pelvic tumor by less experienced physicians and surgeons. We present an extremely rare case of ectopic kidney in the deep subcutaneous region of the abdominal wall and associated with the additional abnormality of spina bifida. MRI found an ectopic kidney but failed to identify ureteropelvic drainage. Diuretic renography with 99mTc-diethylenetriaminepentaacetic acid showed normal functioning and identified nonobstructive ureteropelvic drainage of the ectopic subcutaneous kidney.

Case Report of Living Kidney Transplantation Using Ectopic Pelvic Kidney Harvested by Reduced Port Laparoscopic Donor Nephrectomy

Bloody Urine after Minor Trauma in a Child: Isolated Renal Injury versus Congenital Anomaly?