Congenital Pelvic Kidney Research Articles

Endovascular Repair of an Inflammatory Abdominal Aortic Aneurysm Combined with a Congenital Pelvic Kidney: Case Report and Literature Review.

The coexistence of an abdominal aortic aneurysm and a congenital pelvic kidney is extremely rare. We present a 66-year-old male with an inflammatory aneurysm and an aberrant origin of the superior mesenteric artery. The inflammatory infrarenal abdominal aortic aneurysm with a congenital left pelvic kidney was successfully treated with endovascular repair. Coverage of one out of the two renal ectopic arteries was performed, without clinical evidence of renal function impairment.

Topic Stent versus stentless pyeloplasty in congenital pelvic ureteric junction obstruction kidney in children

Topic Stent versus stentless pyeloplasty in congenital pelvic ureteric junction obstruction kidney in children

Surgical Excision of Endometriosis in the Setting of a Congenital Pelvic Kidney

Study Objective To demonstrate the surgical technique and anatomic consideration for excision of endometriosis in the setting of congenital pelvic kidney and demonstrate surgical technique for excision of appendiceal endometriosis. Design Video of case-presentation. Setting Academic hospital. Patients or Participants Single surgical patient. Interventions Surgical technique used for excision of endometriosis, requiring bilateral ureterolysis and appendectomy. Measurements and Main Results A 37-year-old G2P1012 woman presented with a history of chronic right lower quadrant pelvic pain, dysmenorrhea, and abnormal uterine bleeding. Her history was notable for recurrent urinary tract infections, nephrolithiasis, and known congenital malrotation of bilateral kidneys and a left congenital pelvic kidney. Prior surgical history significant for diagnostic laparoscopy with ablation of suspected endometriosis. Patient had trialed and failed multiple medical therapies. Congenital pelvic kidney was noted to be in close proximity to left adnexa on transvaginal ultrasound. Give her history of a pelvic kidney, a preoperative CT urogram was ordered to evaluate location of kidneys and ureters, as well as associated vasculature. Given completion of childbearing and desire for surgical management, she was consented for total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. Intraoperatively she was found to have extensive endometriosis with multiple lesions noted throughout the pelvis, including the perinephric peritoneum overlying the left pelvic kidney and left ureter, requiring bilateral ureterolysis. An appendectomy was also performed due to endometriosis overlying the appendix, cecum and surrounding pericolic adipose tissue. The entire procedure was performed laparoscopically and without complication. Histopathology confirmed final diagnosis of endometriosis of all submitted specimens, including the appendix. Patient with routine postoperative course, but notable for significant improvement of pelvic pain and a restored quality of life. Conclusion A congenital pelvic kidney is uncommon and requires knowledge of aberrant pelvic anatomy prior to surgical dissection of retroperitoneal spaces. Excision of endometriosis reduces symptom recurrence and an appendectomy should be performed when there is appendiceal involvement. To demonstrate the surgical technique and anatomic consideration for excision of endometriosis in the setting of congenital pelvic kidney and demonstrate surgical technique for excision of appendiceal endometriosis. Video of case-presentation. Academic hospital. Single surgical patient. Surgical technique used for excision of endometriosis, requiring bilateral ureterolysis and appendectomy. A 37-year-old G2P1012 woman presented with a history of chronic right lower quadrant pelvic pain, dysmenorrhea, and abnormal uterine bleeding. Her history was notable for recurrent urinary tract infections, nephrolithiasis, and known congenital malrotation of bilateral kidneys and a left congenital pelvic kidney. Prior surgical history significant for diagnostic laparoscopy with ablation of suspected endometriosis. Patient had trialed and failed multiple medical therapies. Congenital pelvic kidney was noted to be in close proximity to left adnexa on transvaginal ultrasound. Give her history of a pelvic kidney, a preoperative CT urogram was ordered to evaluate location of kidneys and ureters, as well as associated vasculature. Given completion of childbearing and desire for surgical management, she was consented for total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. Intraoperatively she was found to have extensive endometriosis with multiple lesions noted throughout the pelvis, including the perinephric peritoneum overlying the left pelvic kidney and left ureter, requiring bilateral ureterolysis. An appendectomy was also performed due to endometriosis overlying the appendix, cecum and surrounding pericolic adipose tissue. The entire procedure was performed laparoscopically and without complication. Histopathology confirmed final diagnosis of endometriosis of all submitted specimens, including the appendix. Patient with routine postoperative course, but notable for significant improvement of pelvic pain and a restored quality of life. A congenital pelvic kidney is uncommon and requires knowledge of aberrant pelvic anatomy prior to surgical dissection of retroperitoneal spaces. Excision of endometriosis reduces symptom recurrence and an appendectomy should be performed when there is appendiceal involvement.

Isolated iliac artery aneurysm in association with congenital pelvic kidney treated with iliac branch device: case report

BackgroundAssociation of abdominal aortic aneurysm with congenital pelvic kidney is rare and association with isolated iliac artery aneurysm is not yet described in the literature.Case presentationWe present a case of successful repair of an isolated common iliac artery aneurysm associated with a congenital pelvic kidney treated by an endovascular technique. A 75-year-old man was referred for the treatment of an asymptomatic left common iliac artery aneurysm. A computed tomography angiography revealed an isolated left common iliac artery aneurysm and a left pelvic kidney. The maximum diameter of the aneurysm was 32 mm. The congenital pelvic kidney was supplied by three small superior polar arteries that emerged from the proximal non-aneurysmal portion of the common iliac artery and the main artery that arose from the left internal iliac artery. The aneurysm exclusion was accomplished by using an iliac branch device (Gore Excluder Iliac Branch, Flagstaff, AZ). The 1 and 6 months computed tomography angiography after the procedure demonstrated complete exclusion of the aneurysm and preservation of all renal arteries.ConclusionTreating patients with an association of iliac artery aneurysms and pelvic kidneys can be a challenge due the variable arterial anatomy. The use of iliac branch device is a safe and effective alternative in selected cases.

Management of Aortoiliac Aneurysms with Atypical Renal Artery Anatomy

Renal artery anomalies occur at a rate of 1-2% and present a challenge to vascular surgeons performing aortic surgery. We describe adjuncts used to manage such anatomic variants. A single surgeon registry of all abdominal aortic aneurysms repaired in an academic center was retrospectively reviewed. Patients with prior renal transplants, congenital pelvic kidneys, or horseshoe kidneys were included. Open repair was reserved for patients with no endovascular or hybrid repair options. Over an 8-year period, 18 patients were identified (renal transplant n=9, horseshoe kidney n=3, congenital pelvic kidney n=6). All transplant patients were treated with endovascular repair. Four required cross-femoral bypasses, 1 for retrograde allograft perfusion after aorto-uni-iliac (AUI) procedure to the contralateral external iliac artery and 3 for contralateral limb perfusion after endograft extension into iliac artery ipsilateral to allograft. Three transplant patients required carotid access due to severe iliofemoral occlusive disease or allograft origin off the internal iliac artery. Two horseshoe kidney patients underwent open repair with direct reimplantation of accessory renal arteries, whereas 1 underwent endovascular repair with exclusion of an isthmus branch. Of the congenital single/pelvic kidney cohort, 2 underwent open repair with renal reimplantation, 2 underwent endovascular aneurysm repair, 1 was treated with AUI and cross-femoral bypass, and one was treated with a staged iliorenal bypass and subsequent fenestrated endovascular repair. Intravascular ultrasound was used to minimize contrast use in patients with chronic renal insufficiency (Cr>1.5mg/dL, n=6). Over a mean follow-up of 31months (range, 1-110), there were no aortic deaths or reintervention, no decline in renal function (measured by serum creatinine and glomerular filtration rate), and 100% patency of the preserved renal arteries. Atypical renal anatomy should not preclude repair of aortic aneurysms. Repair of such aneurysms is safe and achieves good long-term outcomes with the use of the described techniques.

Abdominal aortic aneurysm and congenital pelvic kidney

Abdominal aortic aneurysm and congenital pelvic kidney

IP001. Hybrid Fenestrated Repair of a Juxtarenal Aneurysm With Congenital Pelvic Kidney

IP001. Hybrid Fenestrated Repair of a Juxtarenal Aneurysm With Congenital Pelvic Kidney

3D CT Angiography of Infrarenal Abdominal Aortic Aneurysm with Associated Ectopic Pelvic Kidney: A Case Report of Rare Concomitance

The abdominal aortic aneurysm (AAA) associated with congenital pelvic kidney is a rare clinical finding. We present a case of an infrarenal AAA with associated congenital left pelvic kidney followed up for 5 years, which was managed by regular surveillance. We describe this case to assist physicians and radiologists to recognize small aneurysms by computed tomography angiography (CTA) with low radiation dose and low iodine dose. To the best of our knowledge, this case is the first report by using CTA with the combination of low-concentration contrast medium, low radiation dose and iterative reconstruction. Keywords: Abdommen, aortic aneurysm, computed tomography angiography, congenital anomaly, pelvic kidney.

Bilateral Malrotation and a Congenital Pelvic Kidney with Varied Vasculature and Altered Hilar Anatomy.

Variations of structure and position of the kidney along with variations of renal vessels are most frequently reported. Rotational variations form a rare entity that are not cited in most embryology textbooks. During an educational cadaveric dissection of a 42-year-old male, a complex picture of bilateral anatomical variants was encountered. Malrotation of both kidneys and a left lobulated ectopic kidney along with open hilum was observed. The left kidney showed a pelvic position in front of sacral promontory with three renal arteries retaining its embryological aortoiliac branches and two renal veins draining into right common iliac vein. These variations have an embryological base. Pelvic kidney with rotational variation though comparatively rare assumes great importance in view of present-day surgical procedures like laparoscopic radical nephrectomy, percutaneous nephrectomy, and renal transplantation.

Aortoiliac aneurysm with congenital right pelvic kidney

The association of congenital pelvic kidney with abdominal aortoiliac aneurysm is an extremely rare clinical finding. Previous reports have described various methods of aneurysm repair with successful preservation of the function of pelvic kidney. However, to our knowledge, reconstruction of more than two renal arteries has not been established. We report a case of abdominal aortic aneurysm complicated by congenital right pelvic kidney in a 72-year-old man. Computed tomography (CT) revealed an abdominal aortic aneurysm with a maximum diameter of 54mm and a right common iliac aneurysm of 45mm. In addition, he had a congenital right pelvic kidney and CT angiography identified three right pelvic renal arteries. The upper artery originated from the bifurcation of the terminal aorta and the lower two originated from the right common iliac artery. Three-dimensional CT was helpful for the accurate planning of the operation. Open surgical repair of the aortoiliac aneurysm with a Dacron bifurcated graft replacement was decided and reimplantation of all three right pelvic kidney arteries to the right limb of the graft was also performed. For renal preservation, the right pelvic kidney arteries were perfused with cold Ringer's lactate using a rapid infusion pump and coronary perfusion cannula. The patient's postoperative course was uneventful, and worsening of renal function was not observed. The perfusion of renal arteries with cold Ringer's solution was thought to be a simple and appropriate procedure for renal protection.

A Case of Abdominal Aortic Aneurysm with Congenital Pelvic Kidney

A Case of Abdominal Aortic Aneurysm with Congenital Pelvic Kidney

Large stone burden in a congenital solitary pelvic kidney

Large stone burden in a congenital solitary pelvic kidney

Customised Stent Graft for Complex Thoraco-abdominal Aneurysm Associated with Congenital Pelvic Kidney

The association of aortic aneurysm with congenital pelvic kidney is an uncommon condition and has been described in association with abdominal aortic aneurysm (AAA) open repairs. We present a case of a patient with a type IV thoraco-abdominal aortic aneurysm (TAAA) extending into the left common and internal iliac arteries associated with a congenital pelvic kidney who was treated with a customised endovascular prosthesis involving proximal fenestrations, bifurcation fenestration and a left internal deep iliac branch device. Although branch technology continues to evolve, cases such as this are encouraging for future widespread use. This approach allowed us to offer TAAA repair without compromising renal function in a patient with multiple co-morbidities who probably would not have withstood conventional open treatment.

Chronic type B dissecting aortoiliac aneurysm repair complicated by congenital pelvic kidney

Although the association between abdominal aortic aneurysm and pelvic kidney is rare, previous reports have described various methods of repair with successful preservation of pelvic kidney function. We describe a unique case complicated by aortic dissection. Successful intra-operative perfusion of the kidney was maintained via a temporary axillorenal shunt.

Aorto-iliac aneurysm associated with congenital pelvic kidney: A short series of successful open repairs under hypothermic selective renal perfusion

The occurrence of congenital pelvic kidney (cPK) during aorto-iliac aneurysm repair is an extremely unusual finding. We report a series of four patients with aorto-iliac aneurysm and associated cPK who underwent aorto-iliac repair at our institution over the last 10 years. Aorto-iliac aneurysm repair under cPK selective hypothermic perfusion was successfully accomplished in all cases. All the cPK arteries were spared and were selectively reimplanted when required. No major complications or death were reported at long-term follow-up. Open surgical repair of aorto-iliac aneurysm in patients with cPK is safe and effective and, in our short series, we observed no worsening of the renal function; besides, we reported a persistent improvement of the renal function in two out of the four cases.

Stage IIB carcinoma of the cervix that is associated with pelvic kidney: A therapeutic dilemma

Locally advanced cervical cancer with congenital pelvic kidney is reported uncommonly. A 50-year-old patient with stage IIB cervical cancer and pelvic kidney was treated with irradiation and concurrent chemotherapy. Follow-up evaluation for 2 years revealed normal renal function and no evidence of recurrent disease.

Renal Function after Elective Infrarenal Aortic Aneurysm Repair in Patients with Pelvic Kidneys

Pelvic kidneys complicate aortic reconstructions because of increased risk of renal ischemia. Strategies for protection include shunting, cooling, and reliance on collaterals. A review identified two congenital pelvic kidney (not solitary) and five transplanted kidney patients who underwent elective abdominal aortic aneurysm repair. For congenital pelvic kidneys, topical cooling was used in one patient while no preservation was performed for the other patient. Three transplanted kidney patients were shunted, and one had endovascular repair. Postoperative creatinine values were compared to preoperative values. The two congenital pelvic kidney patients had no significant elevation of creatinine postoperatively. The transplanted kidney patient who underwent endovascular repair had no increase in creatinine postoperatively. All transplanted kidney patients who had open repair had significant but transient increase in creatinine postoperatively. Three patients who were shunted intraoperatively had normalization of creatinine. The patient who had persistent elevation of creatinine at discharge was not shunted. Aortorenal shunting or endovascular repair in transplanted pelvic kidney patients maintains renal function. For patients with congenital pelvic kidneys and adequate collaterals, cooling and collateral perfusion is usually sufficient. Though experience is limited, endovascular repair is likely to be superior to open repair in minimizing renal ischemia.

Percutaneous nephrolithotomy for ectopic kidneys: Over, around, or through

Objectives The treatment of patients with complex urolithiasis in ectopic kidneys can be challenging. Because the location of an ectopic kidney can vary, each case requires a unique and, at times, unconventional approach. We reviewed the techniques we have developed to treat such patients, including laparoscopic-assisted tubeless, transhepatic, and transiliac percutaneous nephrolithotomy (PNL). Methods We performed a retrospective analysis of all patients with congenital pelvic kidneys who underwent PNL at our institution. Six patients underwent laparoscopic-assisted PNL, one underwent transiliac PNL, and one underwent transhepatic PNL. All laparoscopic-assisted procedures were performed tubeless, with an internalized ureteral stent placed at the conclusion of the procedure. Results All patients underwent successful PNL. On computed tomography, performed on the morning of postoperative day 1, all patients who underwent laparoscopic-assisted PNL were stone free. The patients who underwent transiliac PNL and transhepatic PNL required secondary procedures to attain a stone-free status. The mean length of hospitalization was 3 days for the laparoscopic-assisted cohort, 1 day for the transhepatic patient, and 3 days for the transiliac patient. Conclusions For the patient with a large or complex stone burden in an ectopic kidney, laparoscopic-assisted PNL is the optimal treatment. Performing such a procedure tubeless may be associated with a reduced hospital stay. For those patients with a hostile peritoneal cavity owing to prior surgical exploration, consideration should be given to a more individualized approach.

Pelvic Kidney and Aorto-iliac Aneurysm—A Rare Association—Case Report and Literature Review

Association of a congenital pelvic kidney with abdominal aortic aneurysm is rare and to date only a handful cases have been reported in literature. We report one such case, which was successfully treated using the technique of temporary extra-anatomical perfusion of the kidney.

Laparoscopic Pyelovesicostomy for Ureteropelvic Junction Obstruction in a Pelvic Kidney

Pyelovesicostomy is an attractive option for treatment of ureteral obstruction in a congenital pelvic kidney or a renal allograft. We describe the first laparoscopic performance of this procedure. The total operative time was 207 minutes.