CASE REPORTS
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Initial haemoglobin values may remain unchanged despite significant haemorrhage. Renal ultrasonography may not detect the injury. Appropriate evaluation requires abdominal CT imaging, as in our patient (Fig. 2), to stage the injury and direct a management plan that must include in-patient monitoring, fluid resuscitation and possible blood transfusions. Out-patient lithotripsy requires observation and monitoring to ensure adequate recovery prior to discharge. Reference Stoller, M. L., Litt, L. and Salazar, R. (1989).Severe hemorrhage after extracorporeal shock wave lithotripsy. Ann. Inr Med., 111,612-613. Requests for reprints to: L. S. Baskin, Department of Urology, U-518, University of California, San Francisco, California 94143, USA.
Urothelial Tumour of Renal Pelvis in Patient with Crossed Ectopia
Fig. 1 Intravenous urogram showing low-lying, left-to-right, crossed fused ectopia and an ill defined filling defect of the inferomedial pelvis of the fused kidney.
S.LIU, H. LEUNG and J. CONSlDINE,Departmentof Urology, East Birmingham Hospital, Birmingham
Case Report A 74-year-old man presented with 2 episodes of frank painless haematuria. He had no other urinary symptoms and physical examination was normal. Intravenous urography showed a low-lying,left-to-right, crossed fused ectopia (Weiss and Mills, 1989) which appeared to have an ill defined 2-cm filiing defect of the inferomedial pelvis (Fig. 1). This was subsequently confirmed by retrograde pyelography performed via the “left” ureteric orifice (Fig. 2). A provisional diagnosis of renal pelvic tumour was made, although urine cytology was negative. In order to delineate the vascular anatomy of this ectopic kidney, pre-operative aortography and selective renal angiography were carried out (Fig. 3). An anterior transperitoneal exploration of the kidney was performed followed by hemi-nephroureterectomy of the lower moiety of the fused kidney and its draining ureter. Histology of the renal pelvic tumour confirmed a grade I1 transitional cell carcinoma with no evidence of muscular invasion. There was no clinical or operative evidence of metastatic disease.
Comment Crossed fused renal ectopia is a rare congenital anomaly which has an autopsy incidence of 1 in
Fig. 2 Retrograde pyelogram via the crossed ureter confirming a space-occupying lesion of the inferomedial pelvis of the fused kidney.
2000. It is probably produced by abnormal development of the ureteric bud (Marshall and Friedman, 1978). The incidence of urothelial tumour in crossed ectopia is unknown and the association has not been reported previously.
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BRITISH JOURNAL OF UROLOGY
References MarshdI, F. F. and Freedman, M. T. (1978). Crossed renal ectopia. J . Urol.,119, 188. Weiss, M. A. and Mills, S. E. (1989). Anomalies of the urinary tract. In Atlas of Genitourinary Tract Disorders. Volume 11. Chapter 4, section 10. London: Cower Medical. Requests for reprints to: S. Liu, Department of Urology, East Birmingham Hospital, 45 Bordesley Green East, Birmingham B9 5ST.
Fig. 3 Aortogram showing the anomalous blood supply to the crossed ectopic kidney.
215
Initial haemoglobin values may remain unchanged despite significant haemorrhage. Renal ultrasonography may not detect the injury. Appropriate evaluation requires abdominal CT imaging, as in our patient (Fig. 2), to stage the injury and direct a management plan that must include in-patient monitoring, fluid resuscitation and possible blood transfusions. Out-patient lithotripsy requires observation and monitoring to ensure adequate recovery prior to discharge. Reference Stoller, M. L., Litt, L. and Salazar, R. (1989).Severe hemorrhage after extracorporeal shock wave lithotripsy. Ann. Inr Med., 111,612-613. Requests for reprints to: L. S. Baskin, Department of Urology, U-518, University of California, San Francisco, California 94143, USA.
Urothelial Tumour of Renal Pelvis in Patient with Crossed Ectopia
Fig. 1 Intravenous urogram showing low-lying, left-to-right, crossed fused ectopia and an ill defined filling defect of the inferomedial pelvis of the fused kidney.
S.LIU, H. LEUNG and J. CONSlDINE,Departmentof Urology, East Birmingham Hospital, Birmingham
Case Report A 74-year-old man presented with 2 episodes of frank painless haematuria. He had no other urinary symptoms and physical examination was normal. Intravenous urography showed a low-lying,left-to-right, crossed fused ectopia (Weiss and Mills, 1989) which appeared to have an ill defined 2-cm filiing defect of the inferomedial pelvis (Fig. 1). This was subsequently confirmed by retrograde pyelography performed via the “left” ureteric orifice (Fig. 2). A provisional diagnosis of renal pelvic tumour was made, although urine cytology was negative. In order to delineate the vascular anatomy of this ectopic kidney, pre-operative aortography and selective renal angiography were carried out (Fig. 3). An anterior transperitoneal exploration of the kidney was performed followed by hemi-nephroureterectomy of the lower moiety of the fused kidney and its draining ureter. Histology of the renal pelvic tumour confirmed a grade I1 transitional cell carcinoma with no evidence of muscular invasion. There was no clinical or operative evidence of metastatic disease.
Comment Crossed fused renal ectopia is a rare congenital anomaly which has an autopsy incidence of 1 in
Fig. 2 Retrograde pyelogram via the crossed ureter confirming a space-occupying lesion of the inferomedial pelvis of the fused kidney.
2000. It is probably produced by abnormal development of the ureteric bud (Marshall and Friedman, 1978). The incidence of urothelial tumour in crossed ectopia is unknown and the association has not been reported previously.
216
BRITISH JOURNAL OF UROLOGY
References MarshdI, F. F. and Freedman, M. T. (1978). Crossed renal ectopia. J . Urol.,119, 188. Weiss, M. A. and Mills, S. E. (1989). Anomalies of the urinary tract. In Atlas of Genitourinary Tract Disorders. Volume 11. Chapter 4, section 10. London: Cower Medical. Requests for reprints to: S. Liu, Department of Urology, East Birmingham Hospital, 45 Bordesley Green East, Birmingham B9 5ST.
Fig. 3 Aortogram showing the anomalous blood supply to the crossed ectopic kidney.
