Solitary Left Kidney Research Articles

Rare Cause of Pediatric Abdominal Pain Diagnosed on Point of Care Ultrasound (POCUS)

An 11-year-old postmenarchal female presented to the pediatric emergency department (ED) with 2 days of periumbilical and right lower abdominal pain. Radiology-performed ultrasound (RADUS) did not visualize the appendix, and there was a plan for surgical consultation to decide between serial abdominal exams versus computed tomography (CT) scan. While awaiting consultation and to help further narrow the differential diagnosis, the emergency provider performed a point of care ultrasound (POCUS) of the urinary tract. This revealed several anomalies including a solitary left kidney with hydronephrosis, and a well-circumscribed, fluid-filled structure with mixed echogenicity posterior to the bladder and inferior to the uterus. Given these findings on POCUS, further imaging was pursued, including a RADUS of the pelvis followed by a magnetic resonance imaging (MRI) of the abdomen. Further imaging ultimately diagnosed a bicornuate uterus, septate vagina with hematocolpos and solitary left kidney consistent with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome. This case is an illustration of how POCUS is an invaluable tool to narrow the differential diagnosis and guide advanced imaging or consultation for both common and rare causes of pediatric abdominal pain.

Neglected ureteral stent in a patient with chronic kidney disease and solitary functioning kidney: case report and review of literature

Introduction: A ureteral stent is crucial for managing urinary flow obstruction, ureteral reconstructive surgeries, and iatrogenic ureteral injuries. The authors aim to report a case of forgotten double-J stent for 17 years, the longest time reported in literature in a patient with solitary kidney and no typical long-term complications as stones formation and encrustation. Case presentation: A 58-year-old male with chronic kidney disease and solitary left kidney presented with left loin pain. With creatinine higher than baseline (6.2 mg/dl), he reported a neglected double-J stent placed 17 years ago in a different hospital. In addition, non-contrast computed tomography and cystoscopy revealed hydronephrosis, cystitis, and an element of infra-vesical obstruction, evident by high bladder neck. Treatment included left percutaneous nephrostomy, but he was readmitted few weeks later for cystoscopy, ureteroscopy, and a new double-J insertion. Due to worsening renal function, he was readmitted four weeks later for cystoscopic removal of the new double-J stent and Transurethral Resection of the Prostate, after which creatinine returned to baseline. Discussion: Double-J stents are vital in urological procedures, but neglecting their presence can lead to severe complications like encrustations, stone formation, stent fractures, hydronephrosis, infections, and renal function loss. Treatment of long-term complications is difficult and should consider many factors, including the type and severity of associated complications and the patient’s preoperative status. Conclusion: Preventing complications from neglected or forgotten double-J stents through patient education and follow-up is crucial, especially in those with solitary functioning kidneys due to the imminent loss of renal function.

Case Report: Incidental finding of Zinner syndrome in an asymptomatic 53-year-old Palestinian male

IntroductionZinner syndrome (ZS) is a rare condition characterized by a triad of seminal vesicle cyst (SVC), ipsilateral ejaculatory duct obstruction, and ipsilateral renal agenesis. The diagnosis is often delayed due to non-specific symptoms, such as lower urinary tract symptoms and infertility, typically appearing in the second and third decades of life.Case presentationWe present the first published case of ZS in Palestine, involving a 53-year-old male patient who sought medical attention for right-sided hernia repair. Pre-operative imaging revealed a combination of findings, including a solitary left kidney with cysts, mild hydronephrosis, an enlarged prostate, suspicious soft tissue density, and abnormal lymph nodes. The diagnosis of ZS was confirmed through an abdominal ultrasound, identifying a dilated seminal vesicle and completing the criteria of ZS.DiscussionThe typical for ZS is to present in late second decade of life with nonspecific urogenital symptoms and infertility, However, our patient’s incidental diagnosis during the preoperative evaluation of incisional hernia in a relatively old age with no previous complaints, the identification of a high aortic bifurcation at the level of the left kidney and a double Inferior Vena Cava (IVC) in this case of ZS represents novel and distinctive findings not commonly reported in previous cases.ConclusionOur patient’s presentation and findings expand our understanding of the anatomical variations associated with ZS. This case report contributes to the advancement of knowledge in the field of ZS and provides valuable insights for future clinical management and research investigations.

Knotted Stent—Emphasizing the Need of Radiology Assistance in Urology

Ureteral double-J stents have become a part and parcel in contemporary urologic practice. As the use of stents is increasing, the complications are also increasing. Knot formation in the double-J stent is rare phenomenon. Twenty-seven cases have been reported till now. This case would be the 28th case to be reported, in a young male with solitary left kidney and who was on regular periodic stent substitution.

V10-12 COMPLEX PARTIAL NEPHRECTOMY IN SOLITARY KIDNEY

You have accessJournal of UrologyCME1 May 2022V10-12 COMPLEX PARTIAL NEPHRECTOMY IN SOLITARY KIDNEY Nimrod Barashi Gozal, Brijesh Patel, Mark Biebel, Joseph Ippolito, and Robert Figenshau Nimrod Barashi GozalNimrod Barashi Gozal More articles by this author , Brijesh PatelBrijesh Patel More articles by this author , Mark BiebelMark Biebel More articles by this author , Joseph IppolitoJoseph Ippolito More articles by this author , and Robert FigenshauRobert Figenshau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of renal masses in solitary kidneys can pose a challenging dilemma. Important considerations include feasibility of mass resection with adequate renorrhaphy, limiting ischemia time, and preservation of nephrons to avoid dialysis. We present a complex robot-assisted partial nephrectomy (RAPN) in a 55 year-old female with a solitary left kidney, incidentally found to have a 5.7cm left renal mass that was centrally located, completely endophytic, with a R.E.N.A.L Nephrometry score of 11, and a baseline creatinine of 1.06 mg/dL. METHODS: The patient was placed in right lateral decubitus position with the left flank flexed. Pneumoperitoneum was achieved with a Veress needle, and four robotic 8 mm ports were placed in a straight line along the lateral edge of the rectus with a 12 mm assistant port in the midline. A remotely operated suction irrigation (ROSI) system was utilized. After the colon was medialized, hilar dissection was started with identifying the renal vein (RV), and immediately posterior and cephalad was the renal artery (RA). Intraoperative ultrasonography was performed to demarcate borders of mass excision, since the mass was completely endophytic. Approximately 50% of mass excision was performed with selective clamping of the artery supplying the tumor, but the main RA was eventually clamped to help control bleeding. The mass, along with a segment of tumor thrombus, was grossly excised to completion. Renorrhaphy was started with a 3-0 v-lock suture over-sewing the base of mass excision to control bleeding followed by simple interrupted 0-vicryl suture to bring edges of resection together. These were secured with two Hem-o-lok clips. Gerota’s fascia was re-approximated with a 3-0 v-lock suture, and the specimen was placed in a Endocatch bag for extraction through a Gibson incision. RESULTS: Procedure time was 5 hours and 13 minutes. Estimated blood loss (EBL) was 1,500 mL. Pathology showed clear cell RCC, Furhman grade 3, with lymphovascular invasion and a positive surgical margin at the RV. Post-operatively, the patient experienced a oliguric renal failure, with creatinine (Cr) peaking at 8.5 mg/dL on postoperative day 4. Following that, urine output increased to over 2 liters daily, and Cr fell to 5.5 mg/dL by POD#9, at which time the patient was discharged. At one month follow-up, Cr was 1.49 mg/dL. At no point did the patient have any dialysis needs. CONCLUSIONS: A number of difficult challenges exist for complex RAPN in solitary kidneys. Performing as much of the procedure as possible without clamping the main renal artery may increase blood loss but will also facilitate renal recovery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e852 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nimrod Barashi Gozal More articles by this author Brijesh Patel More articles by this author Mark Biebel More articles by this author Joseph Ippolito More articles by this author Robert Figenshau More articles by this author Expand All Advertisement PDF DownloadLoading ...

Hemoragie renală acută într-un caz de rinichi unic congenital şi angiomiolipom

Renal angiomyolipoma is the most common solid renal mass arising from the mesenchymal elements of the kidney. The complications include acute renal hemorrhage, one of the most common clinical urological emergencies. We pre­sent the case of a 64-year-old female patient with non­spe­ci­fic general symptoms, known with solitary left congenital kidney and renal angiomyolipoma. The contrast-enhanced computed tomography (CECT) allowed to detect the pre­sence of renal hematoma with active bleeding from an ar­te­rial feeding vessel, and the presence of intratumoral fat. Renal angiography via right femoral approach with di­gi­tal subtraction acquisitions (DSA) demonstrated active blee­ding within the lesion; the embolization of the feeding ar­te­rial vessel with multiple tornado-type metallic coils was performed with subsequent reduction of blood flow. CECT studies are essential for a proper management of com­pli­ca­ted renal angiomyolipomas. Endovascular therapy is a viable, minimally invasive alternative to classical ne­phrec­to­my for the control of renal bleeding.

Is neoadjuvant chemotherapy necessary for the surgical treatment of renal tuberculosis?

The relevance of urogenital tuberculosis remains high as well as its social significance. With the advent of anti-tuberculosis drugs it became possible to perform organ-preserving surgeries, both anti-tuberculosis chemotherapy in the preoperative period and after surgery is extremely important. Violation of this principle leads to the development of severe complications, which is demonstrated by clinical observation. Patient I., female 40 years. Diagnosis: polycavernous tuberculosis of the right kidney, cavernous tuberculosis of the left kidney, bladder tuberculosis of stage 4 (microcystis). Her anti-tuberculosis therapy was irregular and occasionally. In the general urology department a laparoscopic nephrectomy on the right and nephrostomy on the left were performed. Anti-tuberculosis therapy was discontinued, which led to the progression of renal failure and repeated attacks of pyelonephritis. In this regards she was re-operated in the Avicenna Medical Center: laparoscopic cavernotomy of the left solitary kidney and cystectomy with enterocystoplasty by Studer were performed. In the postoperative period a reservoir-uterine fistula was formed. She did not receive anti-tuberculosis therapy. The patient returned to the Avicenna Medical Center after 9 months, laparoscopic removal of the shrunken intestinal reservoir was performed with the formation of Bricker ileal conduit with a good short-term and long-term (follow-up period of 10 months) result.

Measurement of glomerular filtration rate reveals that subcapsular injection of shear-thinning hyaluronic acid hydrogels does not impair kidney function in mice.

The continued development of minimally invasive therapeutic implants, such as injectable hydrogels, necessitates the concurrent advancement of methods to best assess their biocompatibility via functional outcomes in vivo. Biomaterial implants have been studied to treat kidney disease; however, assessment of biocompatibility has been limited to biomarker and histological assessments. Techniques now exist to measure kidney function serially in vivo in murine studies via transcutaneous measurements of glomerular filtration rate (tGFR). In this study, adult male and female wild‐type BalbC mice underwent right unilateral nephrectomy. The remaining solitary left kidney was allowed 4 weeks to recover via compensatory hypertrophy, after which subcapsular injection of either saline or shear‐thinning hyaluronic acid hydrogel was performed. Serial tGFR measurements before and after treatment were used to assess the effect of hydrogel injection on kidney filtration. Urine and serum biomarkers of kidney function, and kidney histology were also quantified. Hydrogel injection did not affect kidney function, as assessed by tGFR. Results were in agreement with standard metrics of serum and urine biomarkers of injury as well as histological assessment of inflammation. The model developed provides a direct functional assessment of implant compatibility for the treatment of kidney disease and impact on kidney function.

Delayed Diagnosis of Congenital Hypoparathyroidism in a Kindred of Three Patients With Autosomal Dominant Deafness

Background: Congenital hypoparathyroidism can be related to autosomal dominant mutations or deletions in GATA-binding protein 3 gene on chromosome 101,2. Affected patients present with a triad of hypoparathyroidism, renal dysplasia and neurosensorial deafness. We hereby present the case of a patient with the rare Barakat syndrome, also known as HDR syndrome. Clinical Case: A 11-year-old girl, diagnosed with deafness at birth, was brought to medical attention because of menorrhagia requiring blood transfusions two months after menarche. A pelvic ultrasound demonstrated a septate uterus as well as right multicystic dysplastic kidney with solitary left kidney and ovary. As her maternal grandmother, mother and older sister suffered from congenital deafness and her mother also had a kidney cyst, the patient was referred to genetics to identify a unifying cause of the autosomal dominant pattern of deafness and urogenital anomalies. Chromosome microarray analysis revealed a copy number change on chromosome 10p14 of 1925 kb predicted to result in the deletion of a single protein coding gene, GATA3. Embryonically, GATA3 is involved in the development of the inner ear, kidneys and parathyroid glands. The patient was lost to follow up so that a serum calcium was drawn three years later, revealing low ionized calcium of 1.06 mmol/L (N 1.16–1.29), low corrected total calcium of 2.11 mmol/L (N 2.30–2.62) along with PTH of 1.1 pmol/L (N 2.0–9.4), PO4 of 1.73 mmol/L (N 1.03–1.78) and creatinine of 64 umol/L (N 50–71). She was started on calcium carbonate 1000 mg TID and calcitriol 0.5 mcg BID and genetic analysis of the mother and sister revealed the same mutation compatible with Barakat syndrome. Compliance has been difficult, and when the patient transitioned to adult endocrinology three years later, she was on alfacalcidiol 2 mcg daily along with calcium carbonate 1500 mg daily and her labs were still suboptimal with a total corrected calcium of 1.82 mmol/L (N 2.22–2.54) and ionized calcium 0.98 mmol/L (N 1.16–1.29). Renal function determines the prognosis, and reassuringly her creatinine remains normal. Upon further questioning of the mother, she recalls that the patient had to be intubated for respiratory failure as a newborn, she had delayed milestones and also had seizure like activity during her infancy and early childhood. She had brought these symptoms to her family physician’s attention however no further investigations were completed and serum calcium was not checked.Conclusion: Early recognition of hypocalcemia symptoms is critical in identifying patients with congenital hypoparathyroidism, even more so when associated with other features that are part of complex familial syndrome such as Barakat syndrome.1. Barakat, AJ. Barakat syndrome revisited. Am J of Med Genet A. 2018, Jun; 176(6):1341–13482. Barakat, AY. Familial nephrosis, nerve deafness and hypoparathyroidism. J Pediatri. 1977;9(1):61

Continuous medical education activities; Case No. 3

A 25-year-old male with a history of spina bifida in the lumbar region, type II diabetes mellitus, solitary left kidney, neurogenic bladder and bowel presented to the emergency department with fever, nausea, and vomiting. On examination, there were multiple sacral ulcers, with the largest stage 4 ulcer present on the left buttock and measuring 5 cm in diameter by 5 cm deep with purulent drainage. A swab specimen of the wound from the left buttock ulcer was initially sent for culture. Following processing and incubation in the laboratory, this culture grew seven different colony-types with no predominant type. A more representative specimen was requested. The patient was subsequently taken to the operating room for debridement. Tissue obtained during this procedure from the ulcer bed was sent for culture. The specimen was cultured on blood agar and chocolate agar. The media were incubated at 35°C in 5% CO2 for 24-48 hours. Following incubation, there was a predominant growth of many tiny grey colonies on chocolate agar. These colonies were small and β-hemolytic on blood agar (To be continued).

532\xa0nm green-light laser vaporization of upper tract urothelial carcinoma

BackgroundEndoscopic management of low risk upper tract urothelial carcinoma (UTUC) may be considered in select clinical scenarios, which allows sparing the morbidity of radical nephroureterectomy while achieving acceptable oncological outcomes and preservation of kidney function. Herein, we present a case with UTUC in a solitary kidney managed with 532 nm laser vaporization through a percutaneous approach.Case presentationThe patient in this video (Additional file 1) is an 85-year-old woman who presented with a bulky tumor in the collecting system of a congenital solitary left kidney, which was a biopsy proven low grade urothelial carcinoma. Prior to the procedure, a lower pole percutaneous nephrostomy tube was successfully placed under sedation by Interventional Radiology. The procedure was done in a prone split leg position. The mass, which was predominantly localized to the renal pelvis was efficiently vaporized with the 532 nm laser in a systematic manner with continuous irrigation of normal saline through the cystoscope. The patient was discharged home on postoperative day 2 with the nephroureterostomy catheter open to drainage. This catheter was subsequently clamped and removed two weeks later without complications. Follow up uretroscopy showed excellent treatment response and the patient remains well without complications.ConclusionThis case report details the potential utility of 532 nm laser vaporization of UTUC, however, ongoing studies are required to demonstrate peri-operative safety and durable oncologic efficacy.

Robot-Assisted Laparoscopic Resection of the Mesonephric Duct Remnant in a Patient with Zinner Syndrome.

Introduction: A 17-year-old male with Zinner syndrome, a right seminal vesicle cyst, and a solitary left kidney presented with chronic pelvic pain. Previous surgeons had attempted robot-assisted laparoscopic seminal vesicle cyst aspiration and transurethral resection of the ejaculatory duct. Neither surgery provided sustained symptom relief. Abdominal and pelvic MRI showed a cystic structure lodged between the prostate and bladder. The right seminal vesicle, kidney, and ureter were not observed. Materials and Methods: A robot-assisted laparoscopic seminal vesiculectomy was planned. Dissection distal to the right vas deferens and between the bladder neck and prostate revealed a cystic seminal vesicle-like structure. Attached to this was a tubular structure coursing deep to the vas deferens from the right renal fossa. This was presumed to be a dysplastic ureter. The dysplastic ureter was transected from the seminal vesicle and the seminal vesicle was marsupialized to the deep pelvis. Proximally, the dysplastic ureter was transected and left open. Results: Histologic assessment of the specimen revealed an ∼12.1 cm tubular mesonephric remnant. The postoperative course was uncomplicated. At 6 months follow-up, the patient remains free of symptoms with preserved ejaculatory volume. Conclusions: Mesonephric duct abnormalities and symptoms present on a spectrum. We present a safe and effective resection of a mesonephric duct remnant from a 17-year-old male with Zinner syndrome. A robotic approach localized to the right allowed for excellent observation without compromising left-sided genitourinary anatomy. In males presenting with renal agenesis and pelvic symptoms, clinicians should be suspicious of Zinner syndrome and other mesonephric abnormalities.

Extra Hepatic Portal Vein Obstruction with Solitary Left Kidney: A Case Report

Extra Hepatic Portal Vein Obstruction in individual with solitary left kidney is rare occurence. Though there is no etiological association between Extra Hepatic Portal Vein Obstruction and solitary left kidney but the solitary left kidney decides the modality of treatment. Eighteen year lady referred to our institute with menorrhagia for 5 years and ultrasonography finding of splenomegaly and atretic right kidney. Investigations revealed Extra Hepatic Portal Vein Obstruction with multiple cavernoma formation with oesophagogastric varices with right renal agenesis. She successfully underwent splenectomy with devascularisation. Patient with Extra Hepatic Portal Vein Obstruction present mainly with recurrent episodes of variceal bleeding, splenomegaly and hypersplenism. Splenectomy and esophagogastric devascularisation is an effective modality of treatment for patient with Extra Hepatic Portal Vein Obstruction with solitary kidney. Keywords: cavernoma; modified Hassab's operation; Portal vein; unilateral renal agenesis.

Zinner's Syndrome:Report of two cases with different symptoms managed by minimally invasive approach

Abstract Background: Zinner’s syndrome is characterized by triad of seminal vesicle cysts with ipsilateral renal agenesis and ejeculatory duct obstruction. It sometimes becomes symptomatic during reproductive time of the patient. In this article,we present a minimally invasive approach for two patients with Zinner syndrome. Case presentation: First patient was 37 years old man with 5 years history of infertility. Semen analysis was typical for obstructive azoospermia and ultrasonography revealed the absence of left kidney and anechoic pelvic mass with a thick wall. MRI confirmed Zinner’s syndrome showing 9 cm sized seminal vesicle cyst on the posterior of the bladder. The second patient was 18 years old boy with one year history of abdominal-pelvic pain and lower urinary tract symptoms. Ultrasonography revealed the absence of right kidney and fluid-filled cystic lesion behind the bladder. Contrast enhanced CT confirmed Zinner’s syndrome diagnosis showing solitary left kidney with 8 cm sized seminal vesicle cyst on the posterior of the bladder. We performed laparoscopic seminal vesicle cyst excision for both patient successfully. The procedure was performed with transperitoneal access using four trocars for two patients. Conclusions: Laparoscopic approach for seminal vesicle cysts is feasible because it provides quicker recovery and less morbidity. Therefore it should be considered for treating seminal vesicle cysts.

Peutz-Jeghers Syndrome and Its Unusual Association With a Solitary Kidney

Peutz-Jeghers syndrome (PJS) is an unusual hamartomatous polyposis of the gastrointestinal (GI) tract, with pigmentation characterized by mucocutaneous pigmentation, gastrointestinal polyps and elevated cancer risk. The cancer risk is not only for gastrointestinal cancers, but also for cancers at other sites, including the breast, ovary, uterus, cervix, lung, and pancreas. Renal association including polycystic kidney disease, hamartoma and papilloma of the bladder, urinary tract polyps and renal caner has been previously reported with PJS. But to the author's knowledge a solitary kidney has not been reported. 16-year-old male patient was seen in the pediatric gastroenterology clinic for care regarding his most recently diagnosed PJS. Patient had been admitted a few weeks prior for severe abdominal pain with nausea and emesis. KUB demonstrated bowel obstruction and Exploratory laparotomy was subsequently performed with reduction of the intussusception, small bowel resection and removal of around 77 polyps from the small bowel with histology consistent with hamartoma's seen with PJS. He was then referred to the pediatric GI clinic to establish ongoing care related to the underlying diagnosis. The rest of the past medical was not significant. Maternal grandmother had been diagnosed with Colon cancer. Otherwise family history was unknown. Physical examination revealed multiple café-au-lait pigmented macules on the lips and buccal mucosa. Upper endoscopy and colonoscopy was performed. No polyps were noted and biopsies were normal. Laboratory tests indicated normal hemoglobin levels, blood count and liver and renal function. Subsequent Magnetic resonance imaging of the abdomen and pelvis was performed as part of the ongoing diagnostic work up of PJS. A left solitary kidney was noted. To our knowledge, this is the first reported case of a solitary kidney in a patient with PJS. A solitary kidney is a rare association that highlights the importance of evaluating structuraland functional abnormalities of the kidneys as part of the work-up.

Combined Laparoscopic and Vaginal Cervicovaginal Reconstruction Using Acellular Porcine Small Intestinal Submucosa Graft in a Patient with Mayer-Rokitansky-Küster-Hauser Syndrome (U5aC4V4)

To introduce a creation that combines laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome who had a rudimentary cavity (U5aC4V4) [1]. A video article introducing a new surgical technique. A university hospital. A 24-year-old patient had primary amenorrhea and irregular lower abdominal pain for 9 years. The patient was Tanner stage 3 for pubic hair and Tanner stage 4 for breast development. The physical examination revealed no vagina. A primordial uterus and a uterus with a rudimentary cavity were detected by magnetic resonance imaging [2,3]. However, the rudimentary cavity had no hematometra. Magnetic resonance imaging also found a left solitary kidney. The diagnosis was MRKH syndrome with a rudimentary cavity (U5aC4V4) [4]. The patient desired resumption of menses and possible future fertility. Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft was performed. With the Wharton-Sheares-George neovaginoplasty, a vaginal mold with a surrounding SIS graft was inserted into the newly created cavity [5]. Using laparoscopy, the lower uterine segment was incised by shape dissection. The proximal segment of the SIS graft to the lower uterine segment was sutured. A T-shaped intrauterine device with a Foley catheter was fixed in the uterine cavity by the delay of absorbed sutures to prevent cervical or vaginal stenosis. The distal segment of the SIS graft was sutured with the high vaginal or vestibular mucosa vaginally. The operation was successfully completed. The operating time was 2 hours. Hospitalization was 4 days. There were no blood transfusions or complications. The patient had resumption of menses for 2 cycles postoperatively, and she had no dysmenorrhea. The patient did not have sexual intercourse because of the mode in the vagina to prevent vagina stenosis. No cervical stenosis occurred because of the Foley catheter. In the past, a uterus with a rudimentary cavity in patients with MRKH was always excised, and patients lost the chance of menstrual onset and fertility. Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft provided a minimally invasive, safe, and effective surgical option for the young patient with MRKH syndrome with a rudimentary cavity. The technique is not complex, is easy to learn and perform, and provided a result with functional and anatomic satisfaction. No special surgical apparatus is needed with this technique.

Субкапсулярные гематомы почки после контактной уретеролитотрипсии

Renal hematomas (RH) are a rare complication of retrograde endoscopic lithotripsy (REL). This study aimed to investigate the incidence and causes of RH after REL in patients with ureteral stones of different locations. From 2001 to 2016, 1214 REL were performed at the Urology Clinic of the Mechnikov NWSMU. The analyzes of patients who had RH after REL included the following parameters: age, gender, history of upper urinary tract (UUT) surgery and concomitant diseases (diabetes mellitus, hypertension), the baseline kidney function, the stone characteristics and the degree of hydronephrosis observed in the postoperative period, results of laboratory tests, ultrasound and spiral computed tomography (SCT) of the kidneys. Renal hematomas were diagnosed in 4 (0.3%) of 1214 patients aged 36 to 50 years who had obstructive upper ureteral stones measuring from 0.8 to 1.2 cm in diameter. Three of them previously had UUT surgery: two had REL, and one female patient with a solitary left kidney twice underwent percutaneous nephro- and ureterolithotripsy. All four patients had a triad of symptoms: side flank pain, fever, and anemia. In three patients hematomas were diagnosed on day 2-3 and in one it was found two weeks after the surgery. Two of them were managed with conservative therapy, including bed rest and antibiotics. One patient underwent an ultrasound guided puncture and drainage of the hematoma. In the patient with a solitary kidney, laparoscopic drainage of RH was performed due to growing hematoma and aggravating renal insufficiency. Two patients received blood transfusions. Follow-up kidney SCT showed complete resolution of hematomas in all patients. Renal hematomas are a rare but serious complication of REL. The presence of side flank pain, fever and anemia may be indicative of REL and requires a kidney ultrasound. Management of RH should be patient specific, depending on the severity of the patients condition.

A rare life-threatening disease: unilateral kidney compressed by huge chronic spontaneous retroperitoneal hemorrhage.

ObjectivesTo study an uncommon life-threatening disease, spontaneous retroperitoneal and perirenal hemorrhage.Case descriptionsA 69-year-old male presented with pain in the left waist and back of 1 month duration. The renal abscess was suspected by magnetic resonance imaging before operation. The perirenal hematoma was cleaned by operation. In another case, the patient had a functional solitary left kidney compressed by a huge retroperitoneal mass and uropenia appeared.ResultsThe first patient died of adult respiratory distress syndrome after surgery. The second patient died of cardiac insufficiency and pulmonary embolism on the second day after evacuation of retroperitoneal hematoma.ConclusionConservative surgery, such as selective arterial embolization, is a reasonable approach in patients with chronic spontaneous retroperitoneal and perirenal space hemorrhage and with poor general condition. We strongly recommend drainage or interventional therapy, but not a major surgery, in patients with poor condition.

Uterine didelphys with concomitant renal anomalies in both mother and fetus

Abstract Uterine didelphys results from impaired fusion of the paired Mullerian ducts. The incidence of uterine anomalies is believed to be 0.5–2.0% of reproductive-age women, with didelphic uterus accounting for approximately 10%. Uterine didelphys is associated with renal agenesis in approximately 25% of cases. We present a case of didelphys uterus with a left solitary kidney in a mother whose female fetus also demonstrated uterine didelphys with right multicystic dysplastic kidney. This report highlights the significant contribution and complimentary role of fetal MRI in identifying fetal anomalies.

Solitary ureteric ectopia with incontinence: A case report and review of literature

A 5-year-old girl presented with continuous wetting with normal voiding pattern since birth. Ultrasonography (USG) showed a solitary left kidney. Excretory urography showed a normal left kidney. Right kidney was not seen but lower ureter was faintly delineated. Hence, contrast enhanced computed tomography (CECT) was done to look for any right kidney which was not seen on USG. CT showed a normal left kidney with a small ectopic kidney in right hemipelvis but ureteric orifice could not be traced to its insertion. Dimercaptosuccinic acid confirmed it to be a poorly functioning (6%) ectopic right kidney. Cystourethroscopy and vaginoscopy done could not localize the right ureteric orifice. The child underwent right nephrectomy along with excision of ectopic ureter inserting into vagina with complete resolution of her symptoms.