Solitary Pelvic Kidney Research Articles

Robotic pyelolithotomy in a solitary pelvic kidney complicated with fulminant Clostridium difficile: a case report

BackgroundRobotic-assisted surgeries have gradually become the standard of care for many procedures, especially in the field of urology. Despite the widespread use of robotic assistance in surgeries, data on its postoperative complications are extremely limited. We detail a rare presentation of fulminant Clostridium difficile colitis requiring surgical intervention in a patient with a solitary ectopic pelvic kidney who underwent a robotic-assisted pyelolithotomy. Highlights of the most recent management recommendations for C. difficile infection are also presented.Case presentationA 26-year-old Caucasian woman who underwent a robot-assisted pyelolithotomy of a pelvic kidney developed tachycardia, leukocytosis, and severe diarrhea 2 days following surgery. Because of her long history of antibiotic use, her severe symptoms were concerning for C. difficile colitis. This was confirmed by a C. difficile toxin test and a computed tomography scan. She was given recommended antibiotics, but her condition progressively deteriorated. The patient developed fulminant colitis and toxic megacolon, for which she underwent an exploratory laparotomy with subtotal abdominal colectomy and ileostomy creation on the twelfth day of her hospitalization. She fully recovered and was discharged 3 weeks after her subtotal colectomy.ConclusionAlthough robotic surgeries have been shown to have several advantages, risk of postsurgical complications remains. We present a rare case of fulminant C. difficile colitis that complicated a robotic-assisted pyelolithotomy. Active prevention, early detection, and optimization of management are essential to preventing unfavorable outcomes.

A Case Presenting with Solitary Pelvic Kidney.

A Case Presenting with Solitary Pelvic Kidney.

Surgical treatment of abdominal aortic aneurysm with solitary pelvic kidney

Angiología es una revista científica bimensual editada desde 1949. Está dedicada al estudio de las enfermedades vasculares, incluyendo todos los aspectos de la medicina vascular, el diagnóstico no invasivo, el tratamiento quirúrgico tradicional arterial y venoso, así como el mínimamente invasivo y/o endovascular.

Solitary Pelvic Ectopic Kidney and Limb Anomalies: Rare Variant of Acrorenal Syndrome.

Solitary Pelvic Ectopic Kidney and Limb Anomalies: Rare Variant of Acrorenal Syndrome.

Totally encrusted ureteral stent in a 5 years old boy with solitary ectopic pelvic kidney: A case report

Management of retained encrusted ureteral stent is challenging. A 5 years old boy with congenital right solitary pelvic kidney found to have missed totally encrusted ureteral stent with large renal pelvis, ureter and bladder stone. The age of patient, anatomical consideration and severity of encrustation make the management options limited. Single incision and pyelolithotomy, ureterolithotomy and cystolithotomy with removal of the stent was carried out.

Assessment of women who applied for the uterine transplant project as potential candidates for uterus transplantation.

To review the medical charts of women who applied for the uterine transplant project from June 2008 to June 2011 in our hospital retrospectively (18-40 years). The data for 144 women were retrieved, and information was collected on the etiology of uterine factor infertility(UFI); ovarian reserve tests; and accompanying anatomic, infectious, genetic and endocrinological problems. There were 119 patients with primary amenorrhea and uterovaginal agenesis and 25 patients with a history of hysterectomy. The complete Müllerian agenesis patients formed the largest group of the UFI patients with better anti-Müllerian hormone levels and antral follicle count. Anatomical anomalies such as a solitary pelvic kidney may accompany Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) and impede surgery. The mean ages in MRKH, hysterectomy and complete androgen insensitivity syndrome (CAIS) cases were 24.7, 35.0 and 34.4 years, respectively. The karyotype analysis showed 46XX (MRKH) in 109 patients and 46XY (CAIS) in 10 of the primary amenorrhea patients. Hysterectomy may deteriorate ovarian blood flow and decrease ovarian reserve. Fertility preservation may be considered in young woman undergoing hysterectomy.

P11.07: Transabdominal oocyte pick up in a patient with mullerian agenesis and solitary pelvic kidney

P11.07: Transabdominal oocyte pick up in a patient with mullerian agenesis and solitary pelvic kidney

Dilation of the Renal Artery in an Infant: 5 Years Later

A 5-month-old infant with a solitary pelvic kidney presented with severe cardiorespiratory distress and hypertension (220/ 160 mm Hg) that was unresponsive to four antihypertensive medications. A critical ostial renal artery stenosis (near the aortic bifurcation) was treated via the left axillary artery with 3-mm and later 4-mm diameter balloon angioplasty (Figures 1 and 2, arrows). Antihypertensive therapy was gradually tapered nd finally completely stopped by 12 months after dilation. At age 5.5 years, the child is normotensive, is free of medications, and has normal renal function. Follow-up angiography, performed because of anomalous drainage from the portal vein into the lower caval vein (Abernethy malformation), showed no stenosis of the renal artery and good flow into the solitary kidney (Figure 3, arrow).

A double shunt technique for the prevention of ischaemia of a congenital, solitary, pelvic kidney during abdominal aortic aneurysm repair: a case report.

IntroductionCongenital solitary pelvic kidney is a rare condition, and its association with an abdominal aortic aneurysm is even more unusual. To the best of our knowledge, only two such cases have been reported in the literature to date.Case presentationWe report the case of a 59-year-old Caucasian man with a congenital solitary pelvic kidney, who was found to have an abdominal aortic aneurysm 83 mm in diameter. Abdominal computed tomography angiography clearly identified two renal arteries, one originating from the aortic bifurcation. and the other from the proximal portion of the right common iliac artery. At surgery, renal ischaemia was prevented by introduction of an axillofemoral shunt (consisting of two femoral cannulas and a vent tube of extracorporeal circulation) from the right axillary to the right femoral artery, and a second Argyle shunt from the right common iliac artery to the origin of the left renal artery. A 20 mm Dacron tube graft was then implanted. Our patient's postoperative renal function was normal.ConclusionThe renal preservation double shunt technique used in this case seems to be effective during abdominal aortic aneurysm repair.

V1548 COMBINED ROBOT ASSISTED AND PURE LAPAROSCOPIC ILEAL NEOVAGINA CREATION UTILIZING ROBOT SIDE DOCKING AND LAPAROSCOPIC PERINEAL PORT PLACEMENT

You have accessJournal of UrologyReconstruction1 Apr 2010V1548 COMBINED ROBOT ASSISTED AND PURE LAPAROSCOPIC ILEAL NEOVAGINA CREATION UTILIZING ROBOT SIDE DOCKING AND LAPAROSCOPIC PERINEAL PORT PLACEMENT James Brien, Britton Tisdale, Jeremy Tonkin, Michael Fabrizio, and Gerald Jordan James BrienJames Brien More articles by this author , Britton TisdaleBritton Tisdale More articles by this author , Jeremy TonkinJeremy Tonkin More articles by this author , Michael FabrizioMichael Fabrizio More articles by this author , and Gerald JordanGerald Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1300AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome affects at least 1 out of 4500 women, and is characterized by varying degrees of vaginal aplasia, as well as other malformations. Neovaginal construction is possible using several techniques, although no single method is considered ideal. Use of ileum for neovaginal construction is well described, although challenging to accomplish using minimally invasive techniques. We present a case of combined robotic assisted and pure laparoscopic ileal neovagina creation in a MRKH female with complete vaginal agenesis and a solitary pelvic kidney. METHODS Patient positioning was in low lithotomy. After mobilization of ascending colon and terminal ileum, The da Vinci robot was docked on the left side of the patient to allow for simultaneous laparoscopy and perineal access. After dissection of the vaginal plate, a 10-12mm port was placed through the area corresponding to the neovaginal hiatus. The perineal port was useful in the selection and dissection of the ileal segment identified for creation of the neovagina, transilluminating mesentery vascular arcades prior to division, and facilitating construction of the ileal-ileal reanastomosis. The neovaginal ileal segment was transposed to the perineum and matured with interrupted sutures after pull through to the neovaginal hiatus. RESULTS Total operative time was 7 hours 24 minutes and estimated blood loss was 100cc. The patient experienced no significant post-operative complications and was discharged on post operative day 7. Neovaginal cosmesis was good. Hiatus of neovagina was of good caliber and depth of the vaginal limb was sufficient. CONCLUSIONS Combined pure laparoscopy and robotic assisted laparoscopy with robot side docking and placement of a perineal intraperitoneal port is an alternative minimally invasive option for creation of an ileal neovagina while avoiding the morbidity of a laparotomy. Norfolk, VA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e596-e597 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Brien More articles by this author Britton Tisdale More articles by this author Jeremy Tonkin More articles by this author Michael Fabrizio More articles by this author Gerald Jordan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Specific management of acute renal failure caused by an upper ureteral stone in a solitary pelvic kidney

A 36-year-old man presented with left lumbosacral region pain and 2 days of oliguria. Acute renal failure of a solitary pelvic kidney was diagnosed after a blood creatinine test, color Doppler ultrasonography, and magnetic resonance imaging. The cause of the acute renal failure was not clear; however, acute ureteral obstruction was presumed and emergency surgery was performed. The unusual anatomy of the kidney required specific management to find and relieve the cause of the obstruction. We found and cleared an upper ureteral stone by endoscopic surgery after exploring the kidney through open surgery.

Stabilization of Renal Deterioration Caused by Bladder Volume Dependent Obstruction

Previously published data from our unit show the detrimental effect of excessive bladder filling at normal pressure on renal function in chronically dilated renal units. Synchronous cystometry and dynamic renography identified a critical volume of filling that prevents upper tract drainage. In this followup study we determined whether maintaining bladder volume below this critical level would halt renal deterioration. Followup data were collected on 20 patients in the original study. All had progressive renal function deterioration for which no other cause was identified. Creatinine measured nearest to the time of the study renogram served as a baseline and subsequent values were used to monitor renal function. Data were analyzed by the paired Student t test. Complete data were obtained on 14 patients with a mean age of 34.4 years (range 22 to 70). The mean glomerular filtration rate at entry to this part of the study was 42 ml per minute per 1.73 m(2) (range 18 to 69). Four patients had a neuropathic bladder, 4 had posterior urethral valves, 4 had bladder exstrophy, 1 had radiation cystitis, 1 had a solitary pelvic kidney and detrusor failure, 5 had a native bladder and 9 underwent cystoplasty. Drainage was via the native urethra and a Mitrofanoff channel in 7 cases each. Mean followup was 27 months (range 3 to 39). There was no significant difference in mean +/- SD creatinine at baseline vs latest followup (168 +/- 72 vs 185 +/- 90 micromol/l, p >0.05). In patients with bladder volume dependent renal obstruction function can be stabilized by consistently maintaining bladder volume below the critical level.

Large stone burden in a congenital solitary pelvic kidney

Large stone burden in a congenital solitary pelvic kidney

Re: Cinman NM, Okeke Z, Smith AD. Pelvic kidney: Associated diseases and treatment. J Endourol 2007;21:836–842

Journal of EndourologyVol. 22, No. 1 Letter to the EditorRe: Cinman NM, Okeke Z, Smith AD. Pelvic kidney: Associated diseases and treatment. J Endourol 2007;21:836–842Apul Goel and D. DalelaApul GoelSearch for more papers by this author and D. DalelaSearch for more papers by this authorPublished Online:22 Jan 2008https://doi.org/10.1089/end.2007.9856AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Re: Cinman NM, Okeke Z, Smith AD. Pelvic kidney: Associated diseases and treatment. J Endourol 2007;21:836–842." , 22(1), pp. 157–158FiguresReferencesRelatedDetailsCited bySafe Completion of Laparoscopic Anterior Resection in a Patient With a Solitary Pelvic Kidney: A Case ReportAnnals of Coloproctology, Vol. 37, No. 1Right pelvic kidney during intersphincteric resection for locally advanced rectal cancer: a case report10 July 2019 | Journal of Medical Case Reports, Vol. 13, No. 1Association of Renal Ectopia With Fabry's Disease in 3 PatientsThe Journal of Urology, Vol. 181, No. 4 Volume 22Issue 1Jan 2008 InformationMary Ann Liebert, Inc.To cite this article:Apul Goel and D. Dalela.Re: Cinman NM, Okeke Z, Smith AD. Pelvic kidney: Associated diseases and treatment. J Endourol 2007;21:836–842.Journal of Endourology.Jan 2008.157-158.http://doi.org/10.1089/end.2007.9856Published in Volume: 22 Issue 1: January 22, 2008Online Ahead of Print:January 4, 2008PDF download

The importance of preoperative radiological assessment in intersex patients

[1]. They performed laparoscopy in 14 patients among 80 intersex patients, in order to observe gonadal structures, obtain biopsy if necessary and remove them in selected cases. Out of these 14 patients, five cases with androgen insensitivity syndrome (AIS) underwent laparoscopic gonadectomy with subsequent estrogen replacement following gonadal biopsies. As authors emphasized, the procedure is minimally invasive with low morbidity, shorter postoperative recovery period and less formation of cutaneous scars. It also provides magnified and easy access to the pelvic and peritoneal cavity. However, precise radiological evaluation has to be accomplished for the establishment of additional congenital anomalies related with other organ systems, mainly the urinary system in intersex patients. Since the Mullerian ducts develop in association with the Wolffian ducts and derivatives, the clinician must expect renal abnormalities if maldevelopment or absence of Mullerian structures were noticed. For this purpose, use of magnetic resonance imaging (MRI) technique has some advantages over other imaging modalities. Particularly, good contrast resolution and soft tissue visualization allow exact localization of undescended testes or immature gonadal structures. It was reported that in up to 86% of cases with AIS or true hermaphroditism, gonadal structures were localized accurately with MRI [2]. We recently diagnosed a case of complete ASI with solitary pelvic kidney [3]. She was a 16-year-old female who was admitted initially with the chief complaint of amenorrhea. It was seen that her kidney was localized in bony pelvis between the dome of the bladder and sacrum on left side. In addition, gonadal structures were clearly demonstrated in pelvic sections of MRI. So, coexistence of other congenital anomalies in patients with intersex disorders must be kept in mind. Although detailed evaluation is sometimes regarded as unnecessary and time consuming, it gives the precise localization of pelvic organs to the surgeon, preoperatively. In conclusion, during surgical treatment of these patients, especially with minimally invasive techniques like laparoscopy, preoperative assessment with MRI allows the surgical anatomy to be handled easily. In addition, possible intraoperative injuries to other organ systems could be prevented, especially when experience in laparoscopic procedures is not excessive. Certainly, this is not the case for Dr. Chertin and associates, as they successfully operated more than 80 intersex patients, including 14 cases which were laparoscopically managed without any complication.

Complete androgen insensitivity syndrome: report of a case with solitary pelvic kidney

Complete androgen insensitivity syndrome, commonly known as the testicular feminization syndrome, is characterized by a 46, XY karyotype, bilateral testes, absent or hypoplastic Wolffian ducts, and female-appearing external genitalia with diminished axillary and pubic hair development. Although initial diagnosis in the child is difficult, the syndrome must be suspected after puberty if primary amenorrhea is present. Coexistence of genital defects with urologic abnormalities is expected in these cases because of close embryologic origin. However, unilateral renal agenesis with pelvic ectopia of the contralateral kidney does not seem so common. We report a case of testicular feminization syndrome with a solitary kidney located in bony pelvis on the left side.

Severe renovascular hypertension in an infant with congenital solitary pelvic kidney

Renal artery stenosis (RAS) is one of the most common causes of severe arterial hypertension in infants. Its management is very difficult, especially when present in a single kidney. We report a case of severe hypertension caused by RAS of congenital single pelvic kidney in a 4-month-old boy. The patient presented with cardiorespiratory insufficiency that was first treated as acute fulminate myocarditis. Medical treatment of arterial hypertension was disappointing, as it had to be balanced between congestive cardiac failure and acute renal failure. Percutaneous transluminal angioplasty (PTA) done by coronary balloon dilatation catheters through the left axillary access was successful. Following dilatation of the renal artery, blood pressure decreased and its good control was possible by only one drug. With improved medical blood pressure control and normal growth development, the reassessment of clinical therapy options adjusted to a larger vessel size would be possible. Renovascular hypertension due to RAS in infants with a solitary kidney is difficult to control by medical treatment alone. PTA should be considered as a viable option in infants with refractory hypertension due to renal artery stenosis in a solitary kidney, since it has the potential of improving hypertension while preserving renal function.

Solitary pelvic kidney encountered during laparoscopic colectomy

We report a case of solitary pelvic kidney encountered during laparoscopic colectomy. A 55-year-old man was admitted to undergo laparoscopic colectomy for an early sigmoid colon cancer, which had been detected after a polypectomy. The kidneys were not clearly visualized in their normal position by ultrasonography. During the operation, anomalous vessels in the presacral space and a mass covered with fatty tissue were identified. We converted the operation to a mini-laparotomy, and on performing intraoperative ultrasonography a solitary pelvic kidney was detected. An anterior resection was performed without operative complications. Laparoscopic ultrasonography (LUS) and hand-assisted laparoscopic surgery (HALS) should be considered as feasible adjuvants, when difficult situations arise during laparoscopic colectomy. In case of uncertainty about anatomical orientation or identification, it is prudent to convert to open surgery thereby preventing intraoperative complications such as injury to anomalous vessels or the ureter.

Knowledge of the Anomalies of the Big Central Veins Reduces the Morbidity during the Cannulation for Hemodialysis: Description of a Case of Persistent Left Superior Vena Cava and Revision of Literature

The persistence of a left superior vena cava is the result of a lack of an embryological involution of the left anterior cardinal vein. This anomaly is very rare: about 0.3% of the general population. Its incidence increases remarkably from 3–10% in those patients affected with congenital heart disease. Described herein is a case of persistent left superior vena cava, discovered by chance, following the placement of a central venous catheter for hemodialysis. A chest X-ray in projection back-forward showed the central venous catheter along the left sternal margin simulating a placement in the aorta artery. This clinical picture, as described in the literature, is often accompanied by other anatomical anomalies, in our case, by the congenital agenesis of a solitary pelvic kidney. In agreement with the literature and in contrast with what has been reported recently, we sustain that a central venous catheter placed, for any reason, in the persistent left superior vena cava must be removed immediately because it can induce hyperkinetic arrhythmia and cardiac arrest as in our case. Our case report should be a warning that lack of awareness of the anomalies of the big central veins can cause a rise in morbidity.

Knowledge of the Anomalies of the Big Central Veins Reduces the Morbidity during the Cannulation for Hemodialysis: Description of a Case of Persistent Left Superior Vena Cava and Revision of Literature

The persistence of a left superior vena cava is the result of a lack of an embryological involution of the left anterior cardinal vein. This anomaly is very rare: about 0.3% of the general population. Its incidence increases remarkably from 3-10% in those patients affected with congenital heart disease. Described herein is a case of persistent left superior vena cava, discovered by chance, following the placement of a central venous catheter for hemodialysis. A chest X-ray in projection back-forward showed the central venous catheter along the left sternal margin simulating a placement in the aorta artery. This clinical picture, as described in the literature, is often accompanied by other anatomical anomalies, in our case, by the congenital agenesis of a solitary pelvic kidney. In agreement with the literature and in contrast with what has been reported recently, we sustain that a central venous catheter placed, for any reason, in the persistent left superior vena cava must be removed immediately because it can induce hyperkinetic arrhythmia and cardiac arrest as in our case. Our case report should be a warning that lack of awareness of the anomalies of the big central veins can cause a rise in morbidity.