Images in Clinical Urology Retrograde Intrarenal Surgery in Cross-fused Ectopic Kidney Mustafa Resorlu, Mucahit Kabar, Berkan Resorlu, Omer Gokhan Doluoglu, Muhammet Fatih Kilinc, and Tolga Karakan Cross-fused renal ectopia is a rare congenital anomaly in which both kidneys are fused and located on the same side. We report a case of right-to-left cross-fused renal ectopia and nephrolithiasis, in whom retrograde intrarenal surgery was used to treat the stone disease. To our knowledge, this is the first case of retrograde intrarenal surgery of a crossed-fused ectopic kidney. UROLOGY 85: e5ee6, 2015. 2015 Elsevier Inc.
Figure 1. Enhanced computed tomography scan with 3D reconstructions showing a left crossed-fused renal ectopia with anterior orientation of the pelves (A, B) and a 15-mm stone in the middle pole of kidney (C).
Figure 2. Access of flexible ureterorenoscope into the collecting system and fragmentation of the stone.
A
28-year-old male patient presented to our hospital with left flank pain. Abdominal ultrasonography showed left crossed-fused renal ectopia with a 15-mm stone in the anomalous kidney. The computed tomography scan confirmed the existence of a right-to-left crossed-fused renal ectopia with anterior
Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Radiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; and the Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey Address correspondence to: Berkan Resorlu, M.D., Department of Urology, Ankara Training and Research Hospital, Ayvali Mh 182.cd 175.Sk 14/8, Ankara 06010, Turkey. E-mail: [email protected] Submitted: October 3, 2014, accepted (with revisions): October 14, 2014
ª 2015 Elsevier Inc. All Rights Reserved
orientation of the pelves and a 15-mm stone in the middle pole of kidney (Fig. 1). Treatment of stone was planned, and after discussing the risks and benefits of therapeutic options, the patient elected to undergo retrograde intrarenal surgery (RIRS). The procedure was performed under general anesthesia in the lithotomy position. After insertion of a guide wire into the ureteral lumen, retrograde ureteropyelography was done through ureteral catheter to outline the collecting system. We introduced a 9.5-12 F ureteral access sheath and then passed the flexible ureteroscope (Flex X2; Karl Storz, Tuttlingen, Germany) into the collecting system under fluoroscopic imaging (Fig. 2). The stone was visualized and fragmented with dusting technique using http://dx.doi.org/10.1016/j.urology.2014.10.013 0090-4295/15
e5
200 mm holmium:yttrium-aluminum-garnet laser fiber with the settings of 0.8-1.2 J and 5-10 Hz. At the end of the procedure, we placed a double J stent, and the patient was discharged on postoperative day 1. Crossed-fused renal ectopia is a rare congenital malformation with an estimated occurrence of 1 in 1000 live births and 1 in 7500 autopsies.1 This unusual entity may cause renal calculi, and stone disease in this malformation can present challenges to the urologist. Review of literature showed that shock wave lithotripsy and percutaneous nephrolithotomy have been used for treating nephrolithiasis in crossed ectopic kidneys.1-3 But to our knowledge, this is the first case of RIRS for stone treatment in crossed-fused
e6
renal ectopic anomaly. Our case shows that RIRS is a safe and effective minimally invasive treatment modality for medium-sized renal calculi in patient with crossed-fused ectopic kidney.
References 1. Ghosh BC, DeSantis M, Kleyner Y, et al. Crossed fused renal ectopia with calculi. J Am Coll Surg. 2008;206:753. 2. Siegel YI, Lingeman JE. Percutaneous transilial access for stone removal in crossed fused renal ectopia. Urology. 1993;42:82-85. 3. Mishra S, Ganesamoni R, Ganpule AP, et al. Supine percutaneous nephrolithotomy for bilateral complete staghorn calculi in an Lshaped cross-fused renal ectopic anomaly. Urology. 2013;81:e3-e4.
UROLOGY 85 (2), 2015
Figure 1. Enhanced computed tomography scan with 3D reconstructions showing a left crossed-fused renal ectopia with anterior orientation of the pelves (A, B) and a 15-mm stone in the middle pole of kidney (C).
Figure 2. Access of flexible ureterorenoscope into the collecting system and fragmentation of the stone.
A
28-year-old male patient presented to our hospital with left flank pain. Abdominal ultrasonography showed left crossed-fused renal ectopia with a 15-mm stone in the anomalous kidney. The computed tomography scan confirmed the existence of a right-to-left crossed-fused renal ectopia with anterior
Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Radiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; and the Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey Address correspondence to: Berkan Resorlu, M.D., Department of Urology, Ankara Training and Research Hospital, Ayvali Mh 182.cd 175.Sk 14/8, Ankara 06010, Turkey. E-mail: [email protected] Submitted: October 3, 2014, accepted (with revisions): October 14, 2014
ª 2015 Elsevier Inc. All Rights Reserved
orientation of the pelves and a 15-mm stone in the middle pole of kidney (Fig. 1). Treatment of stone was planned, and after discussing the risks and benefits of therapeutic options, the patient elected to undergo retrograde intrarenal surgery (RIRS). The procedure was performed under general anesthesia in the lithotomy position. After insertion of a guide wire into the ureteral lumen, retrograde ureteropyelography was done through ureteral catheter to outline the collecting system. We introduced a 9.5-12 F ureteral access sheath and then passed the flexible ureteroscope (Flex X2; Karl Storz, Tuttlingen, Germany) into the collecting system under fluoroscopic imaging (Fig. 2). The stone was visualized and fragmented with dusting technique using http://dx.doi.org/10.1016/j.urology.2014.10.013 0090-4295/15
e5
200 mm holmium:yttrium-aluminum-garnet laser fiber with the settings of 0.8-1.2 J and 5-10 Hz. At the end of the procedure, we placed a double J stent, and the patient was discharged on postoperative day 1. Crossed-fused renal ectopia is a rare congenital malformation with an estimated occurrence of 1 in 1000 live births and 1 in 7500 autopsies.1 This unusual entity may cause renal calculi, and stone disease in this malformation can present challenges to the urologist. Review of literature showed that shock wave lithotripsy and percutaneous nephrolithotomy have been used for treating nephrolithiasis in crossed ectopic kidneys.1-3 But to our knowledge, this is the first case of RIRS for stone treatment in crossed-fused
e6
renal ectopic anomaly. Our case shows that RIRS is a safe and effective minimally invasive treatment modality for medium-sized renal calculi in patient with crossed-fused ectopic kidney.
References 1. Ghosh BC, DeSantis M, Kleyner Y, et al. Crossed fused renal ectopia with calculi. J Am Coll Surg. 2008;206:753. 2. Siegel YI, Lingeman JE. Percutaneous transilial access for stone removal in crossed fused renal ectopia. Urology. 1993;42:82-85. 3. Mishra S, Ganesamoni R, Ganpule AP, et al. Supine percutaneous nephrolithotomy for bilateral complete staghorn calculi in an Lshaped cross-fused renal ectopic anomaly. Urology. 2013;81:e3-e4.
UROLOGY 85 (2), 2015
