Renal Fossa Research Articles (Page 1)

Local recurrence (LR) in patients treated with surgery for renal cell carcinoma (RCC) remains a significant clinical challenge that requires thorough investigation. Our study aimed to identify the relative risk factors and explore the optimal clinical management of LR. We conducted a non-randomized, observational, retrospective multicentric registry involving multiple Italian urological centers. We included patients treated with surgery (either nephron-sparing or radical nephrectomy) who later developed LR, defined as recurrence in the ipsilateral kidney or renal fossa. Patients with hereditary syndromes or metastatic disease at the time of LR diagnosis were excluded. We reported 135 cases of LR with the following characteristics: most primary lesions were monofocal (85.7%), with a median size of 42 mm (23-53), the median R.E.N.A.L. score was 7 (6-8), and the median Padua score was 7 (6-9). Patients were treated with robot-assisted techniques in 59% of cases, laparoscopic surgery in 32.4%, and open surgery in 8.6%. Nephron-sparing surgery was performed in 75.2% of cases. Ischemia occurred in 61% of the cases, with a median ischemia time of 21 min (15.5-24). Intraoperative complications occurred in 3.8% of cases, while postoperative complications were reported in 13.8%, all of which were grade ≤3 according to the Clavien-Dindo classification. The primary tumors were pT1a in 43.5% of cases, pT1b in 26.3%, pT2 in 14.7% and pT3 in 15.5%. Histologically, 84% of cases were clear cell, 11.3% papillary type 1 or 2, and 3.7% chromophobe. Sarcomatoid/rhabdoid variants were present in 10.5% of cases. The median rate of LR was 1.3% (range 0.2-3.6), while the median time to LR was 18 months (12-39). LR occurred in the ipsilateral kidney in 70.5% of cases and in the ipsilateral renal fossa in 29.5%. The median rate of PSM in LR cases at initial surgery was 2.4% (range 0-4.3), while the median rate of negative surgical margin (NSM) in LR cases at initial surgery was 0.1 (0-0.3). Following LR diagnosis, most patients (49.2%) underwent surgery, 29.1% received cryoablation or radiotherapy, 17.1% received systemic treatment alone, and 4.6% followed a watchful waiting/active surveillance approach. At a median follow-up of 62 months, the highest oncological control in terms of 5-year cancer-specific survival and overall survival rates was achieved in surgically treated patients. The PSM, the histological variant, and their combination were found to be independent variables correlated with the occurrence of LR, with relative risks of 3.62, 2.71, and 8.12, respectively. LR after nephron-sparing or radical nephrectomy represents a significant clinical dilemma. Known risk factors are not always sufficient to predict recurrence, emphasizing the necessity of consistent radiological follow-up per guideline recommendations. Early detection of recurrence and a multidisciplinary approach involving expert centers are crucial for optimizing patient outcomes.

A patient in his mid-40s with a history of gastric ulcer and gastro-oesophageal reflux disease presented with 6 months of left flank discomfort. He was diagnosed with stage III (cT3aN1M0) papillary renal cell carcinoma and received neoadjuvant therapy for 3 months. Follow-up imaging showed partial response with residual carcinoma and metastatic lymphadenopathies. The patient subsequently underwent laparoscopic radical nephrectomy with lymph node dissection. Postoperatively, he developed chylous ascites and subsequent persistent hiccups as unusual complications. Although chylous ascites improved gradually, the hiccups persisted despite non-pharmacological interventions and pharmacological treatments. Finally, the hiccups ceased following the removal of the J-P drain which ended up stimulating the phrenic nerve by the J-P drain at left renal fossa.

Colon cancer presenting as retroperitoneal abscess with colonic fistula in the renal fossa

Percutaneous Management of Extrahepatic Cystic Echinococcosis: Long-Term Outcomes and Insights on Rare Locations.

Robotic pyeloplasty for ureteropelvic junction obstruction is widely being done, but for anomalous kidneys, it is a bit challenging due to abnormal anatomy. The ectopic kidney lies outside renal fossa so the operative challenges it poses are a malrotation kidney, associated vascular anomalies, and short ureter complicating not only access but also the reconstruction. We present a case of right ectopic kidney with gross hydronephrosis due to pelvic ureteric junction obstruction. We further discuss the surgical challenges faced during its management and further outcome.

To investigate further the incidence and types of fetal abnormality identified at a routine 36-week ultrasound examination, which had not been diagnosed in previous scans at 20 weeks and 12 weeks' gestation, and to report the fetal abnormalities that are diagnosed only postnatally. This was a prospective study of 104 151 women with a singleton pregnancy attending for a routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. In each case, a detailed examination was carried out for the diagnosis of fetal abnormality. All women had undergone a previous ultrasound examination at 19 + 0 to 23 + 6 weeks and 95 801 (92.0%) women also had a scan at 11 + 0 to 14 + 1 weeks. We excluded pregnancies with known aneuploidy. Fetal abnormalities were classified according to the affected major organ system, and the type and incidence of new abnormalities were determined. There were four main findings of this study. First, in the study population, abnormality was identified in 2552 (2.5%) fetuses/neonates. Second, at the 36-week scan, abnormality was detected in 2144 (2.1%) fetuses and the most common abnormalities first detected at the 36-week scan were ventricular septal defect, unilateral or bilateral hydronephrosis, unilateral empty renal fossa (with or without pelvic kidney), unilateral or bilateral duplex kidney and mild ventriculomegaly. Third, 1341 (62.5%) of the fetuses with abnormality detected at the 36-week scan had been diagnosed previously during the first or second trimester and therefore, the incidence of abnormality detected for the first time in the third trimester was 0.77% (803/104 151). The most common abnormalities that were diagnosed exclusively for the first time during the third-trimester scan were ovarian cyst, achondroplasia, microcephaly, vein of Galen malformation and hematocolpos. Fourth, the incidence of abnormality detected for the first time postnatally was 0.39% (408/104 151). The most common abnormalities detected for the first time postnatally were polydactyly, oligodactyly or syndactyly, hypospadias/epispadias, mild talipes treated with physiotherapy, ventricular septal defect and isolated cleft palate. The most common abnormalities diagnosed exclusively for the first time postnatally were isolated cleft palate, anal atresia, atrial septal defect and esophageal atresia with fistula. A high proportion of fetal abnormalities are detected for the first time during a routine 36-week scan. Such diagnosis and subsequent management, including the selection of timing and place for delivery and postnatal investigation, could potentially improve postnatal outcome. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Abstract Crossed fused renal ectopia is a rare congenital anomaly. If at all detected, it is incidentally only. A 35-year-old female, during investigation for abdominal pain and lower urinary tract symptoms, was found to have an empty right renal fossa and left crossed renal ectopia with fusion on intravenous pyelography and ultrasonography. In our case, renal function was normal. This anomaly is frequently associated with other abnormal situations such as agenesis, vascular malformation, incontinence, a palpable abdominal mass, urinary tract infection, high incidence of stone formation, and genital anomalies. The importance of adequate imaging is being emphasized through this case report.

Tumour rupture (TR) signifies stage III disease and requires treatment intensification, which includes radiotherapy. We studied the associations between radiological, surgical and pathology TR in children with Wilms tumour (WT) in a United Kingdom multicentre clinical study. The IMPORT (Improving Population Outcomes for Renal Tumours of Childhood) study registered 712 patients between 2012 and 2021. Children with TR on central radiology review (CRR) at diagnosis and/or indication of preoperative TR on surgical forms were included. Correlation between radiology/surgery/pathology findings was made. Total 141 patients had TR identified (69 on CRR, 43 on surgical form and 29 on both), and 124/141 had images available for CRR, and 98/124 had features suggestive of TR on diagnostic CRR (63 magnetic resonance imaging/35 computed tomography). TR was limited to the renal fossa in 47/98 (48%) and intraperitoneal in 51/98 (52%). Three of 98(3%) had upfront surgery, and 87/95 (92%) had TR confirmed on post-chemotherapy preoperative scans. Among 80/98 (82%) cases with TR on CRR and available surgical forms, TR was not confirmed on surgery or pathology in 38/80, giving a false-positive rate of 48%. Preoperative TR was indicated on 72 surgical forms, with images available for CRR in 55. Twenty-six of 55 (47%) were false-negative for TR on CRR and of those 10/26 (38%) had TR confirmed on pathology. Radiology alone should not be used to define TR, as it does not accurately correlate with surgical or pathology findings, and therefore cannot be relied upon for definitive staging and treatment. A multidisciplinary team should take the decision regarding the final abdominal stage and treatment using a multimodality approach considering clinical, radiological, surgical and pathological findings.

Based on a retrospective hospital-based analysis, this study examines the results of retroperitoneal laparoscopic radical nephrectomy for patients with T1-T2 renal cell carcinoma (RCC) from January 2019 to December 2023. Of the 73 patients, 4.1% had TNM stage II tumors and 95.8% had TNM stage I tumors (53.4% T1a and 42.4% T1b). In terms of frequency, clear cell RCC accounted for 84.9%, with papillary RCC coming in at 9.6% and chromophobe RCC at 4.1%. Following surgery, four patients experienced fevers, one needed a blood transfusion, two had infections, and one had emergency surgery. Lumbar masses and hematuria were absent in all patients. Subsequent metastatic lesions and abnormalities of the renal fossa were not observed on follow-up ultrasounds. 4.1% of the deaths after 25.9 months were due to the disease, and 1.4% were caused by accidents. At one, two, three, and four years, the cumulative survival rates were 100%, 97.2%, and 92.8%, respectively. 48.1 months was the mean postoperative survival period. For RCC stages T1-2, retroperitoneal laparoscopic radical nephrectomy offers significant benefits and comparable results to open surgery.

e16511 Background: Currently, targeted agents and immunotherapy are applied to local-regional recurrent renal cell carcinoma (LRRCC). The combination with systemic therapy and stereotactic radiotherapy (SBRT) is worth exploring. In the present study, we aimed to investigate the efficacy and safety profile of sintilimab plus axitinib combined with SBRT in the treatment for LRRCC. Methods: This was a single-arm, phase II study enrolled LRRCC patients (pts), for whom the SBRT can be safety applied for all the recurrent lesions visible on imaging. Eligible pts received sintilimab (200mg, day 1) and axitinib (5mg, bid, day 1-21) in a 21d cycle. SBRT (35-45Gy/5 fractions) was performed before the third administration of sintilimab. The primary endpoint was progression-free survival (PFS). Results: From Oct 2021 to Jan 2024, 19 pts with a median age of 58 (range: 33-74) were enrolled. Among them, 9 (47.37%) pts had clear cell carcinoma. Nine (47.37%) pts were IMDC intermediate (7 pts) or high risk, and 8 (42.11%) pts recurred in less than 1 year after surgery. Seven(36.84%) pts received at least one prior systemic therapy. Four (21.05%) pts had recurrence in the renal fossa, while 3(15.79%) pts in retroperitoneal lymph node, 2(10.53%) pts in retroperitoneal lymph node with renal fossa and 10(52.63%) pts in intra-abdominal soft tissue. With a median follow-up of 9.5 months (range: 3.0-27.1m), 18 pts were evaluable for response. The median tumor volume was 37.47cc (range: 2.44-493.19cc). The overall response rate was 55.56% with 4 complete responses and 6 partial responses per RECIST v1.1. The median time-to-response was 5 months. The local control rate and the disease control rate were 100% and 94.44%, respectively. The median PFS was not reached, and the 9-month PFS rate was 94.44%. All 19 pts were evaluable for toxicity. Any-grade treatment-related adverse events (TRAEs) occurred in 16(84.21%) pts. The most common TRAEs were albuminuria (8/19; 42.11%), nausea (8/19; 42.11%), hypertension (7/19; 36.84%), and diarrhea (7/19; 36.84%). Grade 3 or higher TRAEs occurred in 6/19(31.58%). Conclusions: Sintilimab plus axitinib combined with SBRT showed promising antitumor activity and manageable toxicity in pts with LRRCC. Clinical trial information: ChiCTR2100049523 .

This report explores the diverse spectrum of congenital anomalies of the kidney and urinary tract (CAKUT), ranging from asymptomatic presentations to the most severe form characterized by bilateral renal agenesis. Genitourinary anomalies, a prevalent subset within this domain, account for a significant proportion, constituting 15-20% of anomalies identified during prenatal screening. An ectopic kidney is defined by the presence of an empty renal fossa and the displacement of the kidney from the lumbar region to alternative locations, with the pelvic region emerging as the most prevalent site. The reported case involves bilateral renal ectopia with unilateral duplex kidney. Initial suspicions of a renal anomaly arose during the first trimester, leading to a definitive diagnosis in the second trimester. The patient underwent regular monitoring every four weeks, ultimately delivering a healthy baby at term. This case underscores the frequency of renal anomalies, emphasizing that a considerable proportion remains asymptomatic. These findings contribute to a broader understanding of congenital renal anomalies, their varied manifestations, and the importance of vigilant prenatal screening for early detection and management.

Ectopic kidneys are one the most common forms of renal anomalies. However, intrathoracic kidneys are extremely rare, especially on the right side. Reporting of such cases is relatively very less common in the literature, particularly in the case of females. The current case is an accidental finding noted in a 56-year-old female who came with complaints of diffuse abdominal pain. An initial ultrasound abdomen revealed an absence of the right kidney in the right renal fossa and computer tomography done later revealed a right intrathoracic kidney with a higher origin of the right renal artery (T12 vertebral level). The right ureter was longer and opened into the bladder normally. The author presents this case because of its anatomical, developmental, and clinical importance.

ABSTRACT Renal ectopia refers to the abnormal position of the kidney outside the renal fossa. It may be in sacral, lumbar, thoracic, or subdiaphragmatic regions, of which the latter is extremely rare and may be associated with congenital abnormalities. High renal ectopia is a rare disease that affects 1 in every 22 ectopic kidney occurrences. During the routine cadaveric dissection of a 50-year-old male, we observed an uncommon case of high ascent of the right kidney, up to the bare area of liver. The right kidney was normal in size and shape, and received a renal artery positioned obliquely, 3 mm below the origin of the left renal artery and its vein drained into the hepatic portion of the inferior venacava (IVC). Knowledge about the variations in the positions of the kidneys is very important as cephalad ectopic kidney may pose a challenge for surgical and interventional procedures.

Background-Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of the renal parenchyma and surrounding tissues resulting in gas formation in the renal parenchyma, collecting system and perinephric tissue. It's a life- threatening infection if not detected and treated promptly. High mortality rate in EPN is due to its septic complications. The most common predisposing factors to this entity are uncontrolled diabetes mellitus, immune incompetence, and urinary tract obstruction. While clinically difficult to detect, radiological confirmation can help clinch the diagnosis. A plain x-ray can raise suspicion of abnormal gas shadow in the renal fossa, based on which ultrasonography or computed tomography can be performed. The latter confirms the presence of intrarenal gas and supports the diagnosis of EPN. As the most common gas-forming organisms are E.coli and Klebsiella, treatment can be initiated after a radiological suspicion to prevent sepsis and morbidity. Here, we present 5 cases of EPN diagnosed by various radiological modalities and brief review of existing literature

Kidney lies outside renal fossa, it is called ectopia. The common cause for renal ectopia is failure of ascend during organogenesis. Renal ectopia is not uncommon; however, high renal ectopia is extremely rare. We report a case of male infant with Edward syndrome.

Kidney lying outside renal fossa is referred as ectopic kidney. Hereby we are presenting a rare case of Pelviureteric junction obstruction in a malrotated ectopic kidney with concomitant lithiasis in a 16 year male. He presented with pain in lower abdomen intermittently. On CT scan, a left malrotated ectopic kidney was located in the pelvis near the midline with a 10 mm stone in the lower pole, and having obstructed pattern drainage with moderate hydronephrosis. Open Anderson-Hynes dismembered pyeloplasty was done. Thorough clinical approach with delineating aberrant anatomy of ectopic kidneys and their vascular supply with consideration of unusual functional data on conventional functional renogram is necessary for intervening in malrotated ectopic kidney with concomitant lithiasis.

Simple SummaryIn the last years, metastasis-directed treatments of oligometastatic renal cell carcinoma (RCC) have been widely investigated. Metachronous solitary or oligometastasis from RCC are considered the ideal candidates for target treatments, allowing the achievement of “non-evidence of disease” status. To date, there have been no randomized clinical trials demonstrating the absolute survival benefits of surgical metastasectomy (MST) for oligo progression of RCC compared to systemic treatments. The role of complete MST on oncological outcomes, at the time of local or distant disease recurrence, remains poorly addressed. This is the first study presenting the advantage of minimally invasive MST on long-term (ten years) overall survival probability in patients who experienced oligoprogression of RCC treated at a high-volume center, compared to cases who received ST only.Objectives: The role of surgical metastasectomy (MST) in solitary or oligometastasis from renal cell carcinoma (RCC) and its impact on survival outcomes remains poorly addressed. We evaluated the impact of MST on overall survival (OS) in patients with oligometastatic (m)RCC. Materials and methods: The institutional renal cancer prospective database was examined for cases treated with partial or radical nephrectomy who developed metastatic disease during follow-up. Patients with evidence of clinical metastasis at first diagnosis were excluded. Patients considered unfit for MST received systemic treatment (ST); all others received MST. The impact of MST vs. the ST only cohort was assessed with the Kaplan–Meier method. Age, gender, bilaterality, histology, AJCC stage of primary tumor, surgical margins, local vs. distant metastasis and MST were included in univariable and multivariable regression analyses to assess the predictors of OS. Results: Overall, at a median follow-up of 16 months after primary treatment, 168 patients with RCC developed asynchronous metastasis at the adrenal gland, lung, liver, spleen, peritoneal, renal fossa, bone, nodes, brain and thyroid gland. Nine patients unfit for any treatment were excluded. The site of metastasis was treated with surgical MST (77/159, 48.4%), with or without previous or subsequent ST, while 82/159 cases (51.2%) received ST only. The 2-year, 5-year and 10-year OS probabilities were 93.8%, 82.8% and 79.5%, respectively. After multivariable analysis, MST and the primary tumor AJCC stage were independent predictors of OS probabilities (p = 0.019 and p = 0.035, respectively). After Kaplan–Meier analysis, MST significantly improved OS probabilities versus patients receiving ST (p < 0.001). Limitations: The main drawbacks of our research were the small sample size from a single-tertiary referral institution, as well as the absent or different ST lines in the cohort of patients receiving MST. Conclusions: When an NED status is achievable, surgical MST of mRCC significantly impacts OS, delaying and not precluding further subsequent ST.

MP28-05 THE IMPACT OF METASTASECTOMY ON SURVIVAL OUTCOMES OF RENAL CELL CARCINOMA: A 10-YEAR SINGLE CENTER EXPERIENCE

Surgical Management and Oncologic Outcomes for Local Retroperitoneal Recurrence of Renal Cell Carcinoma After Radical Nephrectomy.

The kidney is injured in up to 10% of patients who experience significant abdominal trauma and approximately 65% of genitourinary tract injuries involve the kidney. Less is known about the management of this kind of trauma in the case of a transplanted kidney, and for this reason, we performed a review of the current literature. A systematic search was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses in all electronic databases; the inclusion criteria regarded all studies reporting on blunt trauma of a transplanted kidney, and the main outcome was the surgical or conservative management strategy of the trauma. A total of eight studies were included in the review and they were all case reports. We also reported our experience of a case of a 51-year-old patient with blunt trauma to his 18-year-old transplanted kidney, who underwent temporary packing of the renal fossa for kidney salvage. Trauma to a transplanted organ is rare, but clinicians will increasingly confront this scenario with the rise in transplantations. Although the management of renal trauma is well established, we are still far from identifying a gold standard for the treatment of transplanted kidney blunt trauma. It has been demonstrated that outcomes for trauma patients with previous organ transplants are not worse than nontransplanted patients; from this point of view, damage control surgery is considered an adequate approach and is applicable to unstable patients unfit for conservative or radiological intervention, and also in the case of a previous transplant. Data from this review and our experience demonstrate that accurate diagnostic profiling and the correct surgical management can allow the transplanted organ to be saved through a damage control approach; compliance with the most up-to-date therapeutic protocols must always guide surgical choices and, in our case, has allowed us to preserve the graft improving the patient’s quality of life.