Ectopic Pelvic Kidney Research Articles

Application of Mixed Reality Technology in the Planning of PCNL for Special Types of Complex Upper Urinary Stones: A Pilot Study

ObjectiveTo evaluate the application of Mixed Reality technology in the planning of ultrasound-guided PCNL for special types of complex upper urinary stones. MethodsClinical data of 15 patients with complex upper urinary stones undergoing ultrasound-guided PCNL were analysed which included pelvic ectopic kidney, horseshoe kidney, spinal deformity, and transplant kidney. Based on preoperative CTU data, digital three-dimensional reconstruction is performed, and AI mixed reality is used to project three-dimensional images in real space. This facilitates preoperative design and planning. The consistency rate of target calyx and channel numbers, stone free rate, total operative time, percutaneous renal access establish time, decrease in hemoglobin level, surgical complications, and postoperative hospital stay are analyzed. ResultsAll patients underwent preoperative planning using mixed reality and successfully completed PCNL. Based on the preoperative planning, we utilized S-PCNL alone or combined with Needle-perc or antegrade/retrograde FURS. The consistency rate between preoperative planning and intraoperative completion was 87.6%. The stone free rate was 80%. The average time for establishing the main tract was 2.3±0.3 minutes, and the average total operative time was 61.5±12.2 minutes. The mean decrease in hemoglobin level was 9.6±1.2 g/L, and the average postoperative hospital stay was 4.6±0.5 days. There were no occurrences of Clavien-Dindo grade≥II complications. ConclusionPreoperative quantification and analysis of imaging data through mixed reality enable three-dimensional visualization and facilitate surgical plans, and effectively avoid the risks of surrounding organ injury in these special urinary stones cases, make complex surgeries smoother and more controllable.

Ectopic pelvic kidney associated with uretero-pelvic junction obstruction: a case report

Ectopic pelvic kidney associated with uretero-pelvic junction obstruction: a case report

Successful Retrograde Intrarenal Surgery for a Large Kidney Stone in a Pelvic Ectopic Kidney: A Case Report and Review of Literature

Successful Retrograde Intrarenal Surgery for a Large Kidney Stone in a Pelvic Ectopic Kidney: A Case Report and Review of Literature

Transperitoneal Laparoscopic Pyelolithotomy in Pelvic Ectopic Kidneys: Experience From a Northern Indian Tertiary Care Institution.

Introduction The ectopic pelvic kidneys have a higher likelihood of developing renal stones due to urinary stasis caused by the abnormal position of the renal pelvis, altered course of the ureter, and kidney malrotation. This retrospective study highlights the safety, efficacy, and feasibility of performing transperitoneal laparoscopic pyelolithotomy in cases of pelvic ectopic kidney. Methodology The 15 patients with ectopic pelvic kidneys and nephrolithiasis underwent laparoscopic pyelolithotomy. The kidney was exposed either by moving the bowel or using a trans-mesocolic approach. A surgical procedure was performed to remove stones from the renal pelvis using laparoscopic forceps. Following the placement of a double J stent, the incision in the renal pelvis was closed. The procedure was completed after the intraperitoneal drain was inserted. Results A total of 15 patients underwent the transperitoneal laparoscopic pyelolithotomy procedure, with a male-to-female ratio of 3:2. The average age of the patients was 41 (25-58) years, while the average size of the stones was 3.8 cm. Additionally, seven (46.6%) patients had the presence of caliceal stones in conjunction with the pelvic stone. Out of the 15 patients, some had stones on the left side (n = 9, 60%), while others had stones on the right side (n= 6, 40%). The operation with an average duration was 125 minutes with a range of (90-190). Fourteen (93.3%) patients were found to be free of stones. A patient required extracorporeal shock wave lithotripsy (ESWL) to address a small caliceal residual stone measuring 8 mm. After just one session of ESWL, this stone was completely cleared. All stones were successfully removed, resulting in a 100% stone-free rate. Conclusions Laparoscopic pyelolithotomy is a highly effective and efficient procedure for treating large and numerous stones in the ectopic pelvic kidney. This method has a significant level of efficiency in removing stones with limited consequences.

Evaluation of Ectopic Kidney Located at the Deep Subcutaneous Region of the Abdominal Wall: Role of Diuretic Renography with 99mTc-DTPA.

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.

Robotic-Assisted Pyelolithotomy in an Ectopic Pelvic Kidney

Robotic-Assisted Pyelolithotomy in an Ectopic Pelvic Kidney

Autosomal dominant polycystic kidney disease with ectopic unilateral multicystic kidney: a case report

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.

Renal Ectopia in the Pelvic Area: A Rare Case

Renal ectopia is a positional defect during development, consistently accompanied by malrotation, always involving abnormal vascularization with one or more ectopic arteries and a ureter of appropriate length for the location of the kidney. It is distinct from renal ptosis. Several types of ectopias are distinguished: on one hand, simple ectopias occurring in the vertical direction (intrathoracic kidney, low-lying kidney) or in the transverse direction (crossed ectopia), and on the other hand, ectopias with symphyses. Pathological pelvic ectopic kidney is rare. It is often revealed by pain, infectious complications, urinary lithiasis, or sometimes fortuitous discovery. We report the case of a 60-year-old patient with a history of hip prostheses, incidentally discovering, through a diagnostic assessment for nephritic colic due to contralateral ureteral lithiasis, a left ectopic kidney in the pelvic area on a CT scan. Based on this case and literature data, we will discuss the etiopathogenic, clinical, radiological, and therapeutic aspects of this malformation.

Right Ectopic Pelvic Kidney and Bilateral Vascular Aberrations a Female Donor: A Case Report

During an abdominopelvic cavity dissection in an undergraduate gross anatomy course, a right ectopic pelvic kidney was identified in the lesser pelvis and was concomitant with bilateral vascular aberrations. The right kidney was located anterior to the sacrum and medial to the right common iliac artery bifurcation with aberrant vasculature. The left kidney was located near the traditional T12-L3 level; however, multiple aberrant arteries supplied this kidney as well. Such renal anatomy anomalies have immediate implications in anatomy and embryology education, medical imaging, abdominopelvic surgical approaches, and the field of nephrology regarding renal form, function, and pathophysiology.

A rare case of a combination of ectopic kidney and medial arcuate ligament syndrome: a case report

BackgroundEctopic kidney and median arcuate ligament syndrome are both rare conditions. The clinical presentation and diagnosis of these conditions are not well studied. There are no reports on the combination of these two rare conditions.Case presentationWe report a 24-year-old woman with fever, dysuria, urinary frequency and left flank pain for two days. The primary diagnoses in the clinic were left acute pyelonephritis and left hydronephrosis due to throbbing pain in the left costovertebral angle and pyuria. However, further computed tomography showed right ectopic pelvic kidney, left renal pelvis dilatation without definite ureteral lesion, good bilateral renal contrast enhancement, and compression of the celiac axis due to obstruction by the median arcuate ligament. Chronic abdominal symptoms were reported by the patient after repeat history taking. The patient’s condition was fully explained and discussed with her and her family, but they refused further therapy. After the acute pyelonephritis began improving, the patient was discharged for follow-up at our outpatient clinic.ConclusionWe present an extremely rare case of a combination of two rare conditions: ectopic kidney and median arcuate ligament syndrome. No study to date has reported on the relationship between the two diseases. Given the rarity of the two conditions, no evidence or even a hypothesis exists to explain the possible etiology of their combination. More reports are required to enhance the understanding of these rare conditions.

Laparoscopic Approach for Reconstructive and Ablative Procedures in Ectopic Pelvic Kidneys: A Challenge in 8 Cases.

Introduction and Objective: Laparoscopy is the most widely followed approach in ablative or reconstructive kidney surgeries. The aim of this study is to assess the utility and safety of laparoscopic approach in pelvic ectopic kidney surgeries. Methods: Between July 1, 2021 and June 30, 2022, 8 patients with pelvic kidneys; 4 with pelviureteric junction obstruction, 3 with pelvic stones, and 1 nonfunctioning kidney underwent laparoscopic pyeloplasty, pyelolithotomy, and nephrectomy, respectively. The records of all 8 patients were evaluated retrospectively for analyzing the operating time, blood loss, postoperative hospital stay, intra- and postoperative complications, surgical difficulty, and the success in completing the case laparoscopically. The patients were followed for at least 6 months to know the outcome. After pyeloplasty the improvement in function and drainage as well were recorded. Results: Of 8 cases, 6 (75%) were completed laparoscopically. One pyelolithotomy and 1 pyeloplasty patient were converted to open surgery. The median operative time was 180 (140-240) minutes, median blood loss was 100 (50-300) mL, and median hospital stay was 4 (3-6) days. One patient, who had open conversion, had Clavien grade I complication in the form of prolonged fever. Pyeloplasty patients at 6 months follow-up showed improvement in symptoms as well as function. Conclusion: The laparoscopic approach has obvious benefits in pelvic surgeries. Laparoscopy for ectopic pelvic kidneys are challenging due to abnormal anatomy of vessels and kidneys. Proper exposure of kidneys and exact identification of vessels can accomplish laparoscopic procedure in ectopic kidneys successfully with patients having nil complications and early convalescence.

Pelvic Ectopic Kidney Prevalence and Pressure Changes During Cloacal Exstrophy (Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome) Closure

To assess the prevalence of pelvic ectopic kidneys (PEK) and compare renal parameters of the PEK to the orthotopic kidney following pubic bone approximation. In four Omphalocele-Exstrophy-Imperforate Anus-Spinal Defects Syndrome (OEIS) patients undergoing second-stage repair with known pelvic and orthotopic kidneys, changes in the renal pelvis pressure (RPP), peak systolic velocity (PSV), and resistive index (RI) were measured in the pelvic and orthotopic kidneys following pubic bone approximation. A paired t-test was performed for analysis. Prevalence was tabulated using a multi-institutional retrospective review. Mean rise in RPP was +26.0 mmHg in the PEK and +10.3 mmHg in the orthotopic kidney (P = .55). One patient had immediate increase in RPP of 66mmHg in the PEK (7mmHg in the orthotopic kidney) which decreased to +17 mmHg in the PEK upon release of the pubic approximation stitch. Mean change in PSV was +67.7 cm/s in the PEK compared to - 25.7 cm/s in the orthotopic kidney (P = .09). Mean change in renal RI was +0.06 in PEK compared to -0.01 in the orthotopic kidney (P = .29). Among 80 OEIS patients, 24 (30%) had a PEK. 3 (4%) had a solitary PEK. During second-stage OEIS closure, we witnessed patterns of higher change in RPP, PSV, and RI of the PEK compared to the orthotopic kidney. Furthermore, PEKs were found in nearly a third of our OEIS patients. Real-time RPP monitoring, especially those with solitary PEK, may aid in the management of OEIS patients during the perioperative period.

3D-Laparoscopic transperitoneal pyelolithotomy in a rare case of pelvic cake kidney: case report and review of literature

BackgroundBilateral ectopic pelvic kidneys are rarely observed, and cake form of fusion is a relatively distinct anomaly. With the presence of aberrant vasculature and risk of injuring surrounding viscera, conventional treatment of symptomatic calculi with percutaneous and retrograde approaches, become challenging for the urologist. 3D Laparoscopic approach is safe, reduces patient morbidity and avoids open surgery.Case presentationWe herein report a case of 44-year-old female with symptomatic calculi in a pelvic cake kidney, which was adequately managed by 3D laparoscopic transperitoneal pyelolithotomy. Preoperatively, CT imaging and fluoroscopy were performed. The surgery lasted for 156 min, and complete stone clearance was achieved. Postoperative course was uneventful, and patient was discharged in 72 h.Conclusions3D Laparoscopic pyelolithotomy is an acceptable and efficient treatment modality for symptomatic calculi in ectopic fused pelvic kidneys with a malrotated orientation.

Vaginal Atresia, Left Unicornuate Unicollis Uterus, Left Pelvic Ectopic Single Kidney with Right Inguinal Hernia Containing Ovary in a 14 y Old Female: A Rare MRKHS Variant

Introduction: Vaginal atresia is a component of Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS), which includes variable Mullerian duct abnormalities with normal secondary sexual characteristics. Associated renal anomalies are present in about 30% of cases(1)
 Objective: To present a rare variant of MRKHS in a14-y old female with a right ovary in a right inguinal hernia and renal anomalies managed bysigmoid vaginoplasty.
 Case Description: A 14-year-old girl presented with primary amenorrhea and cyclic abdominal painone year before, pelviabdominal swelling, right inguinal hernia, and well-developed secondary sexual characteristics with a single introital opening. Investigations revealed a left ectopic pelvic single kidney, hematometra with left hematosalpinx and right-sided inguinal hernia containing the right ovary with a left ovarian cyst. The first procedure included diagnostic laparoscopy and cystoscopy with the combined repair of the right-sided inguinal hernia and laparoscopic drilling of the left ovarian chocolate cyst. The patient was diagnosed with unicornuate unicollis uterus, left hematosalpinx with complete vaginal atresia associated with a left ectopic pelvic single kidney. One month later, sigmoid vaginoplasty was done. At the 3-month follow-up, there was a full-thickness neovaginal prolapse which was managed surgically by resection.
 Conclusion: To our knowledge, this is the first description of this variant of MRKH syndrome association, includingvaginal atresia, left unicornuate unicollis uterus with ipsilateral left single pelvic ectopic kidney with right-sided inguinal hernia containing right ovary, in the literature. Renal assessment in cases of vaginal atresia and other mullerian anomalies is mandatory for detecting and managing such anomalies and preserving renal function. Anatomical and functional assessment of the urogenital system is mandatory, and multiple modalities can be integrated to get proper results. Diagnostic laparoscopy and cystoscopy give invaluable information in these cases and can add therapeutic aids.

The role of retrograde intrarenal surgery in kidney stones of upper urinary system anomalies

Fusion, pelvic, and duplicated urinary tract anomalies of the kidney are rarely seen. There might be some difficulties in the stone treatment, in the administration of extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and laparoscopic pyelolithotomy procedures in these patients due to the anatomical variations in kidneys with anomalies. To evaluate RIRS results on patients with upper urinary tract anomalies. Data of 35 patients with horseshoe kidney, pelvic ectopic kidney, and double urinary system in two referral centers were reviewed retrospectively. Demographic data, stone characteristics, and postoperative characteristics of the patients were evaluated. The mean age of patients (n=35, 6 women and 29 men) was 50 years. Thirty-nine stones were detected. The total mean stone surface area in all anomaly groups was found to be 140mm2, and the mean operative time was 54.7±24.7 minutes. The rate of using ureteral access sheath (UAS) was very low (5/35). Eight patients needed auxiliary treatment after the operation. The residual rate, which was 33.3% in the first 15 days, decreased to 22.6% in the third month follow-ups. Four patients had minor complications. In patients with horseshoe kidney and duplicated ureteral systems, it was observed that the risk factor increasing the presence of residual stones was the total stone volume. RIRS for kidneys with low and medium stone volume anomalies is an effective treatment method with high stone-free and low complication rates.

Delayed Post-Traumatic Ureteropelvic Junction Obstruction on a Pelvic Ectopic Kidney in a 2-Year-Old Boy: Case Report

This case report highlights the risk of renal injury in the presence of a pelvic kidney following blunt abdominal trauma. The case involved a 2-year-old boy who suffered from pelvic tenderness and total macroscopic hematuria after an abdominal blunt trauma. CT scan revealed a left pelvic kidney with a double pyelic system and pyelocal dilatation, coupled with an inferior polar parenchymatous fracture that extended to the excretory tract. The patient initially received conservative treatment, but later developed ureteropelvic junction obstruction, resulting in surgical intervention with a dismembered pyeloplasty. This case highlights the importance of early diagnosis and follow- up imaging for patients with UPJ lesions and the need for conservative treatment options, such as ureteral stenting or percutaneous nephrostomy, to alleviate obstruction and facilitate the healing process. In all cases of conservatively treated renal trauma, rigorous clinical and radiological monitoring is essential.

Robot-assisted laparoscopic pyeloplasty in an adult with pelvic ectopic kidney with hydronephrosis: a case report and literature review

Pelvic ectopic kidney is a congenital anomaly with a higher probability of hydronephrosis than a normal kidney. Few studies have reported cases of pelvic ectopic kidney with hydronephrosis in adults treated with robot-assisted laparoscopic pyeloplasty (RALP). We performed RALP on a 22-year-old male and he recovered well after the procedure. The patient's pain disappeared after surgery. No complications occurred during the perioperative period and had a rapid postoperative recovery.

A Rare Case of Pediatric Pelvic Ectopic Kidney Injury Management

A Rare Case of Pediatric Pelvic Ectopic Kidney Injury Management

Cold nephroprotection for repair of aortic ectasia and bilateral iliac aneurysms in the presence of pelvic ectopic kidney

Cold nephroprotection for repair of aortic ectasia and bilateral iliac aneurysms in the presence of pelvic ectopic kidney

Bilateral ectopic pelvic kidneys: The novel association with liver hemangioma

Background: Renal ectopia is a congenital abnormality in which one or both kidneys are located in an unusual position because of failure of normal ascend from its origin in the true pelvis. Several types of renal ectopia with or without fusion or other associated renal and abdominal visceral abnormalities have been reported. We have previously reported the case forty-one of crossed unfused renal ectopia, and the aim of this paper is to report the association of bilateral ectopic pelvic kidneys with liver hemangioma. Patients and methods: The case of a woman in her mid-forties with renal and hepatic abnormalities on pelvic and abdominal ultrasound was studied. Results: A woman in her mid-forties was having recurrent lower abdominal pain or discomfort and recurrent urinary tract infection. Ultrasound showed that both kidneys were ectopic and were located in the pelvic cavity. Both kidneys were normal in size, texture, parenchymal thickness, and had normal cortico-modularly differentiation. There was mild splitting of the pelvi-calyceal system suggesting infection. Both ureters were normal. The liver was normal in size with homogenous texture, but there was a right lobe well-defined echogenic soft tissue mass, hemangioma. Renal function tests showed normal findings. Conclusion: Bilateral ectopic pelvic kidneys is a rare congenital condition that has not been reported to occur in association with hepatic hemangioma. This paper reports the novel association of bilateral ectopic pelvic kidneys with hepatic hemangioma.