Traumatic Pseudoaneurysm of the Renal Artery on Ectopic Kidney

The ectopic pelvic kidney is defined as a kidney placed atypically due to abnormal migration from the fetal pelvis during development embryological. Ectopic kidneys can be more exposed to trauma, since they are in a less protected anatomical position. Today, these anomalies are generally noted as fortuitous discoveries during the initial assessment by ultrasound or computed tomography (CT scan). A post-traumatic renal artery pseudoaneurysm rarely occurs after abdominal trauma blunt. Common symptoms include acute hematuria, abdominal pain, a lump pulsatile in the abdomen or flank, or arterial hypertension. We report the case of a patient with post traumatic renal artery pseudoaneurysm on two fortuitously discovered ectopic pelvic kidneys

Open Pyelolithotomy in a Pelvic Ectopic Kidney: Case Report and Current Literature Review

BACKGROUND: Advances in urology have significantly reduced the indications for open surgery to treat staghorn kidney stones. Nevertheless, according to our experience, open surgery is still the preferred treatment for rare cases of the ectopic pelvic kidney. CASE PRESENTATION: A 49-year-old man complained about pain in the lower umbilical region for five months. The pain drastically changed into a sharp pain two months before. The vital sign is normal; on physical examination, the palpation of the suprapubic area elicits pain when pressed, no mass is detected. The abdominal computed tomography without contrast showed a right ectopic kidney located anteriorly of the fifth lumbar to the second sacrum. There was also mild hydronephrosis (grade I) and staghorn stones measuring 4 cm x 2.3 cm. The stone was surgically treated with open pyelolithotomy through a midline infra umbilical incision. The patient was discharged five days postoperatively without distinct complications. CONCLUSION: Open surgery can represent a valid alternative in the treatment of kidney stones of very selected cases, including anomalous kidneys, in a setting where resources are limited.

Congenital ureterovaginal fistula: a rare case of single-system ectopic ureter with ipsilateral ectopic kidney managed by vaginal approach: a case report

Background Diagnosing urinary incontinence from organic causes such as ectopic ureter is particularly important because of the potential for cure by surgical correction. The prevalence of ectopic ureter is uncertain because many are asymptomatic and the diagnosis is usually overlooked. Eighty percent of ectopic ureters in females are often associated with duplex kidney. However, an ectopic ureter draining a single-system ectopic dysplastic/atrophic but functioning kidney is rare, especially in females. The overall long-term continence rate after successful correction of ectopic ureter is satisfactory. Case presentation This case is reported to highlight a rare situation, where a 22-year-old nulligravid Ethiopian women presented with a complaint of continuous wetting of her underwear since childhood, but she had normal voiding pattern. Localized right pelvic kidney ultrasound and computed tomography scan with contrast revealed right ectopic ureter and atrophied ipsilateral pelvic kidney with good function. Surgical reimplantation through vaginal approach was performed, and the outcome was good. The patient’s subsequent follow-ups were uneventful. Conclusion An extramural vaginal ectopic ureter is better accessed through transvaginal approach than abdominal, especially when it is associated with pelvic ectopic kidney. This modified approach is less invasive and has lower morbidity and better success rate than a transabdominal approach.

Laparoscopic Pyelolithotomy for Recurrent Stone in Previously Operated Ectopic Pelvic Kidney

An ectopic kidney is a rare congenital anomaly that has been associated with complications as reflux, hydronephrosis, nephrolithiasis, and sometimes renal failure. Calculous diseases in the pelvic kidney due to their anatomical characteristics pose a significant challenge to the surgeon. We herein report a case of transperitoneal laparoscopic pyelolithotomy for treatment of renal pelvis stone in an ectopic pelvic kidney who had already undergone open pyelolithotomy in past. A 34 years old man presented to our hospital with pain abdomen for five months and a history of left open pyelolithotomy done almost eleven years back. Computed tomography scan revealed severe hydronephrosis and 3.5 cm calculus in the pelvis of ectopic malrotated left kidney. The patient underwent left laparoscopic pyelolithotomy, complete stone clearance was achieved, 20 fr drain was placed with no DJ (Double J) stent. For two consecutive days there was significant drain output, subsequently cystoscopy with DJ stenting was done then drain output was reduced. On fifth postoperative day the drain was removed and he was discharged. In a patient with a malrotated pelvic kidney with recurrent stone and past surgery, proper pre-operative evaluation & the selection of the most appropriate surgical technique play a crucial role to get the best surgical outcome. Keywords: Ectopic kidney, laparoscopy, pyelolithotomy, renal pelvic calculous.

Single-use ureteroscopes in ectopic pelvic kidney stones

We analyzed the results of single-use flexible ureteroscopy (su-fURS) with the holmium laser in treating renal stones associated with ectopic pelvic kidney (EPK). The study retrospectively analyzed data of 11 patients diagnosed with EPK and stone disease who underwent su-fURS between May 2017 and November 2019. The analyzed surgical data included the mean operation time, stone-free and complication rates, as well as hospitalization period. Disposable digital flexible ureteroscopes were exclusively used. The mean age was 55, with a 1.2:1 male to female ratio. The mean stone burden was 30±9 mm (ranging from 17 to 49 mm). The mean calculi digitized surface area (DSA) was 299±56 mm2 (ranging from 170 to 597 mm2). A ureteral access sheath was used in all 11 patients, and holmium laser lithotripsy was performed (dusting mode parameters: low energy – 0.5J, high frequency – 50 Hz, long pulse; pop-corn mode: high energy >1 J, medium frequency– 10–50 Hz, long pulse; fragmenting mode: high energy >1 J, low frequency <10 Hz, short pulse). The average operative time was 78±19 minutes (ranging from 68 to 144 minutes). The stone-free status (residual fragments <3 mm) after one session was 60.1%, 84.1% after the second session, and 94.4% after the third session. The hospitalization period was 29 hours (ranging from 17 to 39 hours). The overall complications rate (according to the Clavien-Dindo system) was 19.7%. Therefore, su-fURS represents an effective therapeutic approach characterized by a remarkably high stone-free rate and few complications in EPK-associated calculi.