scholarly journals Laparoscopic transposition for crossing vessels (vascular hitch) in pure extrinsic pelvic-ureteric junction obstruction: a successful case report of a 2-year-old infant with horseshoe kidney

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Satoshi Ieiri ◽  
Kouji Nagata
Keyword(s):  
Laparoscopic Surgery ◽  
Left Kidney ◽  
Horseshoe Kidney ◽  
Renal Scintigraphy ◽  
Multicystic Dysplastic Kidney ◽  
Extrinsic Compression ◽  
Dysplastic Kidney ◽  
Renal Vessels ◽  
The Right ◽  
Crossing Vessels

Abstract Background Pediatric hydronephrosis induced by pelvic-ureteric junction obstruction (PUJO) is treated by dismembered pyeloplasty (DP) via open and laparoscopic surgery. The etiology of PUJO involves both intrinsic stenosis and extrinsic compression of crossing vessels (CVs). PUJO owing to CVs is also treated by DP, as there is no consensus concerning this vascular condition. We encountered a 2-year-old infant with pure extrinsic PUJO combined with horseshoe kidney who successfully underwent laparoscopic transposition for CVs (vascular hitch). Case presentation A 2-year-old boy was prenatally diagnosed with left multicystic dysplastic kidney (MDCK) and right hydronephrosis and received a definitive diagnosis after birth. At 6 months old, renal scintigraphy revealed a non-functioning pattern in the left kidney and an obstructive pattern in the right, showing no response to furosemide loading. The patient also had recurrent urinary tract infection, and his right hydronephrosis gradually worsened. We decided to perform surgery for the right PUJO. Preoperative enhanced computed tomography detected three right renal vessels independently branching from the abdominal aorta. The middle renal vessels were located at the ventral side of the pelvis and coincident with the site of PUJO. These vessels were suspected of being CVs. The patient underwent laparoscopic surgery electively. A 5-mm trocar was inserted at the umbilicus for a 5-mm, 30° rigid scope. Two additional ports were then inserted under laparoscope inspection. The dilated right pelvis and CVs were detected after ascending colon mobilization. To confirm the pathogenesis of PUJO, the CVs were dissected and taped. After taping the CVs, an intraoperative diuretic test was performed using furosemide loading. Peristalsis of the right ureter was recognized, and the extrinsic PUJO owing to the CVs was definitively confirmed. We therefore performed transposition for the CVs (vascular hitch procedure). The CVs were mobilized in the cranial direction and those were wrapped by dilated pelvis. The post-operative course was uneventful. The renal scintigraphy findings improved and showed a favorable response of furosemide loading. Conclusions The laparoscopic vascular hitch procedure is minimally invasive and effective for extrinsic PUJO due to CVs. Anastomotic stricture after Anderson and Hynes DP can be prevented by appropriate patient selection.

Retroperitoneal laparoscopic surgery in managing the urinary anormalies in children at Viet Duc Hospital

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Việt Hoa Nguyễn
Keyword(s):  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Plastic Surgery ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Multicystic Dysplastic Kidney ◽  
Gender Ratio ◽  
Laparoscopic Pyeloplasty ◽  
Ureteral Duplication ◽  
Dysplastic Kidney

Tóm tắt Đặt vấn đề: Đánh giá kết quả phẫu thuật nội soi sau phúc mạc điều trị bệnh lý thận, tiết niệu ở trẻ em Phương pháp nghiên cứu: Nghiên cứu hồi cứu người bệnh phẫu thuật nội soi sau phúc mạc điều trị bệnh lý thận, tiết niệu trong thời gian từ 1/1/2014 - 31/12/2017. Kết quả: Phẫu thuật nội soi sau phúc mạc cho 110 người bệnh trong đó hẹp khúc nối bể thận - niệu quản là 49 người bệnh (44,54%), thận niệu quản đôi 23 người bệnh (20,91%), thận đa nang 21 người bệnh (19,1%), thận teo mất chức năng 17 người bệnh (15,43%). Tuổi phẫu thuật trung bình là 4,5 ± 3,72 tuổi (từ 1 tuổi- 15 tuổi), tỉ lệ nam/ nữ = 3,3/1. Phẫu thuật nội soi cắt thận cho 52 người bệnh (47,27%), nội soi tạo hình cho 11 người bệnh (10%), nội soi hỗ trợ tạo hình cho 47 người bệnh (42,73%). Thời gian phẫu thuật trung bình 100 ± 20 phút. Thời gian nằm viện sau mổ trung bình là 3 ± 2,3 ngày. Không có biến chứng nặng. Kết quả theo dõi sau mổ 3- 36 tháng cho kết quả tốt 88%, trung bình 10%, xấu 2% Kết luận: Nội soi sau phúc mạc điều trị các bệnh lý thận, tiết niệu ở trẻ em là một phương pháp phẫu thuật an toàn, không có biến chứng, thẩm mỹ và cho kết quả tốt. Abstract Introduction: To evaluate the retroperitoneal laparoscopic surgery in children having the urinary anomalies Material and Methods: Retrospective study for children suffering from urinary anomalies underwent retroperitoneal laparoscopic surgery. Results: 110 children were operated by retroperitoneal laparoscopic approach included: 49 patients (44.54%) with ureter pelvic junction obstruction, 23 patients (20.91%) with ureteral duplication, 21 patients (19.1%) with multicystic dysplastic kidney, 17 patients (15.45%) with atrophy kidney. Mean age was 4.5± 3.72 years old (from 1 year to 15 years old); Gender ratio: male/female = 3.3/1. Laparoscopic nephrectomy for 52 cases (47.27%), 58 cases including 11 cases (10%) retroperitoneal laparoscopic pyeloplasty and 47 cases (42.27%) with assisted laparoscopic plastic surgery. Mean operative time was 100 ± 20 minutes, mean hospitalization length stay was 3 ± 2.3 days. No major complications occurred. Followed from 3 to 36 month are favorable with good outcome in 88%, average in 10%, poor in 2%. Conclusion: Retroperitoneal laparoscopic surgery is safe and feasible procedure in children with urinary anomalies. Keyword: Laparoscopic surgery; Retroperitoneal laparoscopic surgery; Urinary anomalies in children.

scholarly journals Transplantation of Horseshoe Kidney from Living, Genetically Unrelated Donor

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Kazuro Kikkawa ◽  
Takahito Wakamiya ◽  
Hiroki Kusumoto ◽  
Nagahide Matsumura ◽  
Yasuo Kohjimoto ◽  
...  
Keyword(s):  
Surgical Complication ◽  
Iliac Fossa ◽  
Preoperative Evaluation ◽  
Left Kidney ◽  
Fluid Collection ◽  
Horseshoe Kidney ◽  
Left Renal Artery ◽  
Unrelated Donor ◽  
In Situ Perfusion ◽  
The Right

We report a case of renal transplantation using a horseshoe kidney from a living, genetically unrelated donor. The recipient was a 60-year-old man with diabetic nephropathy, and the donor was the 63-year-old wife of the recipient with a horseshoe kidney free of complications. Computed tomography showed two renal arteries and one renal vein on the left side, and the isthmus was perfused by several accessory arteries and veins. To demarcate the boundary of the isthmus, the left renal artery was ligated and cannulated for in situ perfusion. Furthermore, the isthmus was clamped, and the boundary of the isthmus was confirmed. The kidney was divided at the left margin of the perfused boundary. The cut ends of the isthmus were closed by sutures. The left kidney was transplanted into the right iliac fossa of the recipient. Asymptomatic fluid collection occurred on the cut surface at the isthmus of the donor, and this fluid decreased in due course. On the other hand, the recipient experienced no surgical complication or rejection, while maintaining serum creatinine levels of 2.00–2.20 mg/dL over a 22-month follow-up period. Horseshoe kidneys may be used for transplantation in selected cases after a detailed preoperative evaluation.

scholarly journals Indocyanine Green Near-Infrared Fluorescence Imaging-Guided Laparoscopic Heminephrectomy for Left Ureteral Cancer in Patient with Horseshoe Kidney

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Takao Natsuyama ◽  
Yozo Mitsui ◽  
Masato Uetani ◽  
Shigeyuki Ohta ◽  
Shin-ichi Hisasue
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Imaging System ◽  
Left Kidney ◽  
Horseshoe Kidney ◽  
Near Infrared Fluorescence ◽  
Nirf Imaging ◽  
Novel Approach ◽  
The Right ◽  
Near Infrared Fluorescence Imaging

Laparoscopic surgery for patients with a horseshoe kidney is challenging because of the location, aberrant vasculature, and difficulty with division of the isthmus with adequate hemostasis. We herein report performance of a laparoscopic heminephrectomy for left ureteral cancer in a patient with a horseshoe kidney under guidance from near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG). A 62-year-old male was referred to our hospital for treatment of left ureteral cancer associated with a horseshoe kidney. We performed a laparoscopic left nephroureterectomy and bladder resection in June 2017. During the operation, the NIRF imaging system was used to evaluate the border of the kidney parenchyma isthmus after ligation of the left kidney vasculature supply. Interestingly, the dominant region of the right kidney showed strong ICG fluorescence as compared to the left kidney region. With the assistance of ICG-based NIRF imaging, isthmus division was performed with monopolar scissors and adequate hemostasis was obtained by electrocautery coagulation. This is the first report of use of an ICG-based NIRF imaging system and this novel approach can help to demarcate the left moiety isthmus from right one with more certainty.

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

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A189-A189
Author(s):  
Karel Dandurand ◽  
Dalal Ali ◽  
Susan Tran ◽  
Tina Zhou ◽  
Aliya Aziz Khan
Keyword(s):  
Calcium Carbonate ◽  
Serum Calcium ◽  
Autosomal Dominant ◽  
Early Recognition ◽  
Left Kidney ◽  
Ionized Calcium ◽  
Multicystic Dysplastic Kidney ◽  
Medical Attention ◽  
Her Family ◽  
Dysplastic Kidney

Abstract 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

scholarly journals Renal scintigraphy as an early and efficient method for detecting loss of renal function in a cat

2021 ◽  
Vol 7 (2) ◽  
pp. 205511692110625
Author(s):  
Gabriela C Schaefer ◽  
Mariana M Brose ◽  
José R Herrera Becerra ◽  
Fabíola PS Mello ◽  
Inácio B Rovaris ◽  
...  
Keyword(s):  
Renal Function ◽  
Complete Blood Count ◽  
Left Kidney ◽  
Health Assessment ◽  
Serum Biochemistry ◽  
Reference Intervals ◽  
Renal Scintigraphy ◽  
Abdominal Ultrasonography ◽  
Mild Reduction ◽  
The Right

Case summary A 6-year-old mixed-breed male cat was evaluated for a routine annual health assessment. No alterations on physical examination were observed other than mild pain on palpation of the right kidney. Complete blood count, serum biochemistry (including symmetric dimethylarginine), urinalysis and urine protein:creatinine ratio were within the reference intervals for the species. Abdominal ultrasonography showed the presence of asymmetric kidneys, decreased corticomedullary definition, presence of a cyst on the left kidney and moderate renal pelvis dilatation on the right kidney. Dynamic renal scintigraphy (technetium [99mTc]-diethylenetriamine pentaacetic acid) revealed a single functioning kidney on the left. Static renal scintigraphy (99mTc-dimercaptosuccinic acid) exhibited renal activity practically restricted to the left kidney (relative uptake was 99% for the left kidney and 1% for the right kidney). Results of renal scintigraphy showed that the left kidney was compensating for the lack of function of the right one. GFR was 2.17 ml/min/kg, which is considered subclinical renal insufficiency and is in accordance with the case, as the cat was asymptomatic and did not present alterations in laboratory parameters. Relevance and novel information Renal scintigraphy was an important tool to determine the loss of renal function in one of the kidneys and mild reduction of global GFR. In this case report, renal scintigraphy proved to be more sensitive in the assessment of renal function than other tests routinely performed.

scholarly journals Effect of sildenafil in renal ischemia/reperfusion injury in rats

2010 ◽  
Vol 25 (6) ◽  
pp. 490-495 ◽  
Author(s):  
Paulo José de Medeiros ◽  
Arthur Villarim Neto ◽  
Francisco Pignataro Lima ◽  
Ítalo Medeiros Azevedo ◽  
Layra Ribeiro de Sousa Leão ◽  
...  
Keyword(s):  
Ischemia Reperfusion Injury ◽  
Histopathological Examination ◽  
Ischemia Reperfusion ◽  
Left Kidney ◽  
Renal Ischemia ◽  
Renal Scintigraphy ◽  
Control Group ◽  
Left Renal Artery ◽  
Differential Function ◽  
The Right

PURPOSE: To evaluate the effect of sildenafil, administered prior to renal ischemia/reperfusion (I/R), by scintigraphy and histopathological evaluation in rats. METHODS: Twenty-four rats were divided randomly into two groups. They received 0.1 ml of 99mTechnetium-etilenodicisteine intravenous, and a baseline (initial) renal scintigraphy was performed. The rats underwent 60 minutes of ischemia by left renal artery clamping. The right kidney was not manipulated. The sildenafil group (n=12) received orally 1 mg/kg of sildenafil suspension 60 minutes before ischemia. Treatment with saline 0.9% in the control group (n=12). Half of the rats was assessed after 24 hours and half after seven days I/R, with new renal scintigraphy to study differential function. After euthanasia, kidneys were removed and subjected to histopathological examination. For statistical evaluation, Student t and Mann-Whitney tests were used. RESULTS: In the control group rats, the left kidneys had significant functional deficit, seven days after I/R, whose scintigraphic pattern was consistent with acute tubular necrosis, compared with the initial scintigraphy (p<0.05). Sildenafil treatment resulted in better differential function of the left kidneys 24h after reperfusion, compared with controls. Histopathologically, the left kidney of control rats (24 hours after I/R) showed a higher degree of cellular necrosis when compared with the sildenafil treated rats (p<0.05). CONCLUSION: Sildenafil had a protective effect in rat kidneys subjected to normothermic I/R, demonstrated by scintigraphy and histomorphometry.

scholarly journals Bilateral Vascular Variations at the Renal Hilum: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Naveen Kumar ◽  
Ashwini P. Aithal ◽  
Anitha Guru ◽  
Satheesha B. Nayak
Keyword(s):  
Renal Artery ◽  
Left Kidney ◽  
Left Renal Artery ◽  
Anterior Branch ◽  
Precise Knowledge ◽  
Renal Vessels ◽  
Renal Hilum ◽  
Aberrant Artery ◽  
Vascular Structures ◽  
The Right

Imaging technology with its advancement in the field of urology is the boon for the patients who require minimally invasive approaches for various kidney disorders. These approaches require a precise knowledge of the normal and variant anatomy of vascular structures at the hilum of the kidney in terms of their pattern of arrangement and division. The present paper describes a bilateral anomalous arrangement of the structures at the renal hilum as well as their peculiar branching pattern which is of clinical and surgical relevance. Multiple branching of the renal vessels was observed in both kidneys due to which the hila were congested. The right renal artery immediately after its origin divided into 2 branches. The upper branch represented an aberrant artery whereas the lower branch gave 5 divisions. The left renal artery also divided into 2 branches much before the hilum as anterior and posterior divisions. The anterior branch took an arched course and gave 6 branches. The posterior branch gave 3 terminal branches before entering the renal substance. In addition to anomalous hilar structures, normal architecture of both kidneys was altered and the hilum of the left kidney was found on its anterior surface.

scholarly journals Cross ectopic multicystic dysplastic kidney with ureterocele in nonectopic site

2013 ◽  
Vol 4 (3) ◽  
pp. 61 ◽  
Author(s):  
Adnan Narcı ◽  
Mevlit Korkmaz ◽  
Muhittin Karakus ◽  
Tolga Altug Sen ◽  
Îlhamı Surer ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Horseshoe Kidney ◽  
Multicystic Dysplastic Kidney ◽  
Ectopic Ureter ◽  
Normal Kidney ◽  
First Case ◽  
Dysplastic Kidney

Crossed renal ectopy (CRE) is the second most common fusionanomaly of the kidney, with an incidence of 1 in 7000 autopsies;it comes in second after horseshoe kidney. Crossed renal ectopy isassociated with an ectopic ureter and generally an ectopic kidneyfused with a normal kidney. A 7-month-old boy who had left-torightcrossed non-fused renal ectopy and multicystic renal dysplasiawith ureterocele in nonectopic kidney was reported in Englishlanguage literature. In this article, we present the first case of CREwhere surgical intervention has been performed.

Multicystic dysplastic kidney: Assessment of the need for renal scintigraphy and the safety of conservative treatment

2017 ◽  
Vol 41 (1) ◽  
pp. 62-67
Author(s):  
M.E. Carazo-Palacios ◽  
M. Couselo-Jerez ◽  
A. Serrano-Durbá ◽  
B. Pemartín-Comella ◽  
C. Sangüesa-Nebot ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Renal Scintigraphy ◽  
Multicystic Dysplastic Kidney ◽  
Dysplastic Kidney
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