Laparoscopic excision of pelvic kidney with single vaginal ectopic ureter

Ectopic Kidney with an Ectopic Ureter Masquerading Adnexal Mass: A Case Report and Literature Review

An ectopic kidney is a rare congenital defect that is often asymptomatic, but can be incidentally discovered during imaging examinations. Moreover, the morphological characteristics and laboratory features of ectopic kidneys are nonspecific, which may lead to misleading diagnostic approaches, particularly when there are additional factors, such as infection, obstruction, or other anomalies. A 43-year-old female presented with a mass in the left adnexal area. She had septate uterus and a history of congenital urinary incontinence. Ultrasound and MRI findings indicated that the mass was a cyst originating from the ovary. However, it is possible that the lump was derived from the urinary system. To confirm the diagnosis, laparoscopy was performed, followed by pathological examination, which confirmed the presence of an ectopic kidney with a single-system ectopic ureter. The patient underwent nephroureterectomy, and her symptoms successfully resolved, leading to a favorable prognosis. This case report highlights a rare case involving an ectopic kidney with a vaginal ectopic ureter that initially presented as an adnexal cyst and caused urinary dribbling. This case emphasizes the importance of early recognition and accurate diagnosis in women with similar symptoms.

An atrophic crossed fused kidney with an ectopic vaginal ureter causing urine incontinence

An ectopic vaginal ureter is an infrequent cause of urinary incontinence. Most cases are associated with a duplex kidney in which the lower moiety ureter drains into the bladder. Occasionally, some cases of ectopic kidney with single vaginal ectopic ureter can occur. In this study, we present a case of chronic continuous urine incontinence caused by the extremely rare combination of a fused-crossed kidney and a single vaginal ectopic ureter. Laparoscopic nephroureterectomy was carried out smoothly and uneventfully. In our experience, laparoscopic navigation and surgery can be valuable tools to delineate and manage unusual congenital anomalies.

Pelvic kidney: associated diseases and treatment

The incidence of pelvic kidney has been approximated at between 1 in 2200 and 1 in 3000. The ectopic kidney is thought to be no more susceptible to disease than the normally positioned kidney, except for the development of calculi and hydronephrosis. Because of the greater risk of injuring aberrant vessels or overlying abdominal viscera and nerves, the pelvic kidney presents special treatment challenges. Alternative approaches to treating nephrolithiasis may yield better outcomes. The tortuous ureter often associated with a pelvic kidney hinders deflection of the flexible ureteroscope, potentially limiting access. Laparoscopy-guided intervention permits visual exposure of the kidney, enhancing safe puncture and tract placement integral to percutaneous nephrolithotomy. Laparoscopy-assisted anterior retrograde percutaneous nephroscopy involves percutaneous access using a Hunter-Hawkins retrograde nephrostomy needle with adjunctive laparoscopy to permit viewing and manipulation of overlying bowel. Ureteropelvic junction (UPJ) obstruction has been reported to occur in 22% to 37% of ectopic kidneys. Endoscopic incision presents difficulties beyond those of anatomically normal kidneys. The laparoscopic approach provides good surgical exposure, and operative times are comparable to those of laparoscopic pyeloplasty in anatomically normal kidneys. To date, only a handful of cases of malignancy in a pelvic kidney have been described. Like a nonfunctioning anatomically normal kidney, a nonfunctional pelvic kidney may require primary removal. There are a few reports of laparoscopic pelvic nephrectomy. Additional studies are needed to compare the various treatments for disease of the pelvic kidney in order to decide which options have the most beneficial outcomes.

Laparoscopic nephroureterectomy for adult incontinence caused by functioning ectopic pelvic kidney draining into vagina

A 29-year-old woman had been continent of the majority of her urine for her entire life but had constant, uncontrollable dribbling. A contrast CT scan showed a solitary functioning left kidney and a dysplastic right pelvic kidney with a tortuous dilated ureter running close to the vaginal vault. The kidney was removed whole at transperitoneal laparoscopy, rendering the patient continent. This is the first such case reported in an adult.

Laparoscopic removal of multicystic dysplastic pelvic kidney

A patient presented to us with a symptomatic, polycystic, nonfunctioning, pelvic kidney, which was removed laparoscopically. Laparoscopic removal of multicystic pelvic kidney has not been reported in an adult. The technique we adopted is described, and the relevant literature is reviewed.