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Bayrak AC, Fadiloglu E, Kayikci U, İdilman İ, Ozcan HN, Deren O. Pancake kidney and jejunal atresia: An uncommon dual anomaly detected prenatally-A case report. J Clin Ultrasound 2024; 52:478-481. [PMID: 38391149 DOI: 10.1002/jcu.23648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
Pancake kidney is a renal fusion anomaly with only a few reported prenatal diagnoses. Other structural anomalies beyond the urogenital system may also be associated. This study describes a dual anomaly case detected prenatally, comprising of pancake kidney and jejunal atresia. A postnatal abdominal ultrasound confirmed both kidneys were fused in the midline at the aortic bifurcation level, along with a type 3b jejunal atresia. Based on the available limited evidence about pancake kidney, renal functions appear to remain largely preserved and unaffected as in our case according to 6 months of follow-up. However, further investigation is needed to explore any potential association with chromosomal and structural abnormalities in selected cases.
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Affiliation(s)
- Ayse Cigdem Bayrak
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdem Fadiloglu
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Umutcan Kayikci
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlkay İdilman
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H Nursun Ozcan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozgur Deren
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Gong Z, Xia C, Kong W, Yang D. Renal cell carcinoma in horseshoe kidney treated with laparoscopic partial nephrectomy. Asian J Surg 2024; 47:1945-1946. [PMID: 38233275 DOI: 10.1016/j.asjsur.2023.12.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/25/2023] [Indexed: 01/19/2024] Open
Affiliation(s)
- ZhiCong Gong
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chengxin Xia
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Weihao Kong
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Delin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
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Williams Z, Ananthapadmanabhan S, Ranasinghe S, Thangasamy I. Three-dimensional virtual reconstruction guides robot-assisted partial nephrectomy in a horseshoe kidney. BJU Int 2024; 133 Suppl 4:64-67. [PMID: 38178790 DOI: 10.1111/bju.16235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Zoe Williams
- Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Urology Research Group, Kingswood, New South Wales, Australia
| | | | - Sachinka Ranasinghe
- Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Urology Research Group, Kingswood, New South Wales, Australia
| | - Isaac Thangasamy
- Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Urology Research Group, Kingswood, New South Wales, Australia
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Shoji R, Teraishi F, Matsumi Y, Kashima H, Fujiwara T. Robot-assisted laparoscopic surgery for rectal cancer in a patient with a horseshoe kidney: A case report. Asian J Endosc Surg 2024; 17:e13296. [PMID: 38414217 DOI: 10.1111/ases.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/30/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
A 52-year-old, Japanese man presented to the hospital with a complaint of anal bleeding, and detailed examination resulted in a diagnosis of locally advanced rectal cancer. The patient underwent total neoadjuvant therapy followed by short-course radiation therapy and consolidation chemotherapy, which provided a partial response. After preoperative contrast-enhanced computed tomography showed a horseshoe kidney, robot-assisted, precise, laparoscopic, low anterior resection with D3 dissection and ileostomy construction was performed. The horseshoe renal isthmus was elevated surrounding the inferior mesenteric artery, and the left ureter and seminal vessels ran in front of the kidney. The hypogastric nerve traveled ventral to the horseshoe kidney. With robotic surgery, it was possible to perform more precise surgery while recognizing vascular and nerve anatomy in a rectal cancer patient with a horseshoe kidney due to good three-dimensional visibility and articulated forceps manipulation.
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Affiliation(s)
- Ryohei Shoji
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fuminori Teraishi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan
| | - Yuki Matsumi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan
| | - Hajime Kashima
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan
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Yamashita S, Uemura M, Nagai K, Hoshino H, Ota H, Ikushima H, Mizuno H. [A Case of Sigmoid Colon Cancer with Horseshoe Kidney]. Gan To Kagaku Ryoho 2024; 51:463-465. [PMID: 38644323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
We reported a case of sigmoid colon cancer with horseshoe kidney. A 79-year-old man had lower abdominal pain and underwent colonoscopy. The results of colonoscopy revealed sigmoid cancer. Preoperative computed tomography revealed horseshoe kidney. He underwent radical laparoscopic surgery. The histopathological diagnosis was pStage Ⅱa(The 9th Edition). He has not recurred 22 months later after operation. Surgery for colorectal cancer with congenital anomalies of the urinary tract requires attention to intraoperative secondary injuries. Therefore, preoperative evaluation using 3D-CT is useful tool for safety. Operating the proper dissecting normal layer would make safe laparoscopic operation possible without unexpected injuries.
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Ngo XT, El-Achkar A, Dobbs RW, Tiong HY, Chau QT, Tran TT, Van Dinh LQ, Zein M, Le NT, Truong HTT, Tran TS, Thai MS, Nguyen TT. Laparoscopic retroperitoneal heminephrectomy for renal cell carcinoma in horseshoe kidney: a case report and review of the literature. J Med Case Rep 2023; 17:512. [PMID: 38087334 PMCID: PMC10717455 DOI: 10.1186/s13256-023-04274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In this case report, we demonstrate our technique of a retroperitoneal laparoscopic heminephrectomy for a T1b right hilar tumor in a horseshoe kidney. CASE PRESENTATION A 77-year-old Vietnamese woman presented to the hospital because of right flank pain. On presentation, her serum creatinine was 0.86 mg/dL and glomerular filtration rate was 65.2 mL/minute/1.73 m2. According to her renal scintigraphy, glomerular filtration rates of the right and left moieties were 24.2 and 35.5 mL/minute, respectively. Computed tomography imaging demonstrated a 5.5 × 5.0 cm solid hilar mass with a cT1bN0M0 tumor stage was in the right moiety. After discussion, the patient elected a minimally invasive surgery to treat her malignancy. The patient was placed in a flank position. We used Gaur's balloon technique to create the retroperitoneal working space, and four trocar ports were planned for operation. Three arteries were dissected, including two arteries feeding the right moiety, one artery feeding the isthmus, and one vein, which was clipped and divided by Hem-o-lok. The isthmusectomy was performed with an Endostapler. Consequently, the ureter was clipped and divided. Finally, the whole right segment of the horseshoe kidney was mobilized and taken out via the flank incision. RESULTS The total operative time was 250 min with an estimated blood loss of 200 mL. The patient's serum creatinine after surgery was 1.08 mg/dL, and glomerular filtration rate was 49.47 mL/minute/1.73 m2. The patient was discharged on postoperative day #4 without complication. Final pathologic examination of the tumor specimen revealed a Fuhrman grade II clear cell renal cell carcinoma, capsular invasion, with negative surgical margins. After a three-month follow-up, the serum creatinine was 0.95 mg/dL, and glomerular filtration rate was 57.7 mL/minute/1.73 m2. Local recurrence or metastasis was not detected by follow-up computed tomography imaging. CONCLUSIONS Retroperitoneal laparoscopic heminephrectomy is a safe and feasible technique for patients with renal cell carcinoma in a horseshoe kidney and may be particularly useful in low income settings without access to robotic technology.
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Affiliation(s)
- Xuan Thai Ngo
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Ryan W Dobbs
- Cook County Health and Hospitals System, Chicago, IL, USA
| | - Ho Yee Tiong
- National University Hospital, Singapore, Singapore
| | | | | | | | - Marwan Zein
- American University of Beirut, Beirut, Lebanon
| | | | | | | | - Minh Sam Thai
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tuan Thanh Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Cho Ray Hospital, Ho Chi Minh City, Vietnam.
- University of California Irvine, Irvine, USA.
- Department of Urology, UC Irvine Health, 3800 W Chapman Ave, Suite 7200, Orange, CA, 92868, USA.
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Biben E, Menon L, Gokden N, Spond MF, Eichhorn JM, Aydin AM. Giant left pheochromocytoma with vascular anomalies and pelvic horseshoe kidney: a case report. BMC Urol 2023; 23:204. [PMID: 38066479 PMCID: PMC10704855 DOI: 10.1186/s12894-023-01370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Pheochromocytoma is a neuroendocrine tumor, and its treatment is dependent on surgical resection. Due to the wide availability of cross-sectional imaging, pheochromocytomas are commonly seen as small tumors less than 10 cm in size and are mostly treated with minimally invasive surgery. Their concomitant presence with horseshoe kidney or other anatomical and vascular anomalies is rare. Herein, we present a surgically complex giant pheochromocytoma case who underwent an open left radical adrenalectomy. CASE PRESENTATION A 41-year-old Hispanic female presented with a 12 × 8 cm left hypervascular adrenal mass, pelvic horseshoe kidney, and severely dilated large left retro-aortic renal vein which branched into a left adrenal vein, congested left ovarian vein, and left uterine plexus. She was managed with insulin and metformin for uncontrolled diabetes with an A1c level of 9% and doxazosin for persistent hypertension. Clinical diagnosis of pheochromocytoma was confirmed with elevated urine and serum metanephrine and normetanephrine. The pre-operative ACTH was within normal range with a normal dexamethasone suppression test and 24-hour urine free cortisol. The adrenalectomy of the highly aggressive adrenal mass was performed via open approach to obtain adequate surgical exposure. Due to the large size of the tumor and its significant involvement with multiple adjacent structures, coordination with multiple surgical teams and close hemodynamic monitoring by anesthesiology was required for successful patient outcomes including preservation of blood supply to the pelvic horseshoe kidney. The histopathological diagnosis was pheochromocytoma with negative surgical margins. The patient was followed at 1, 4, 12, and 24 weeks postoperatively. She had a normal postoperative eGFR and was able to discontinue antihypertensive and antidiabetic medications at four weeks. She had transient adrenal insufficiency, which resolved at five months. The horseshoe kidney was intact except for a minimal area of hypo-enhancement in the left superior renal moiety due to infarction, which was significantly improved at six months. CONCLUSION Our patient had a giant pheochromocytoma with anatomical variations complicating an already surgically challenging procedure. Nonetheless, with multiple provider collaboration, detailed pre-operative surgical planning, and meticulous perioperative monitoring, radical resection of the giant pheochromocytoma was safe and feasible with successful postoperative outcomes.
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Affiliation(s)
- Emily Biben
- Department of Urology, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Lakshmi Menon
- Department of Endocrinology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Neriman Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Matthew F Spond
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joshua M Eichhorn
- Department of Radiology and Nuclear Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmet Murat Aydin
- Department of Urology, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA.
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Sheahan KP, Thomson B. Laterality Error of Retrograde Ureteric Stent Placement in a Horseshoe Kidney. J Vasc Interv Radiol 2023; 34:2263-2264. [PMID: 37652300 DOI: 10.1016/j.jvir.2023.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Kevin P Sheahan
- Department of Interventional Radiology, Guys and St. Thomas NHS Foundation Trust, London, United Kingdom.
| | - Ben Thomson
- Department of Interventional Radiology, Guys and St. Thomas NHS Foundation Trust, London, United Kingdom
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Chen E, Hackney L, VanHeyst K, Miyasaka EA. Wilms Tumor in Child With Trisomy 18 and Horseshoe Kidney. J Pediatr Hematol Oncol 2023; 45:e1018-e1022. [PMID: 37749779 DOI: 10.1097/mph.0000000000002756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/16/2023] [Indexed: 09/27/2023]
Abstract
Trisomy 18 is associated with several congenital malformations, including horseshoe kidney. It can be full, partial, or mosaic, and mosaicism is often associated with lesser severity and longer life expectancy, placing patients at greater risk of developing neoplasms or malignancies. One common tumor among children with Trisomy 18 is Wilms tumor, which is also associated with renal congenital abnormalities such as horseshoe kidney. We present a case describing the occurrence of these three characteristics: development of Wilms tumor in a patient with Trisomy 18 and a horseshoe kidney and discuss treatment with regards to these conditions.
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Affiliation(s)
| | - Lisa Hackney
- Department of Pediatrics, Division of Pediatric Hematology Oncology
| | - Kristen VanHeyst
- Department of Pediatrics, Division of Pediatric Hematology Oncology
| | - Eiichi A Miyasaka
- Division of Pediatric Surgery, Rainbow Babies and Children's Hospital at University Hospitals Cleveland Medical Center, Cleveland, OH
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Maugeri O, Di Grazia E, D'Arrigo L, Agliozzo R, Calvano G, Trovato F, Di Gaetano C, Trefiletti G, Privitera S, Russo GI, Cimino S. Supine mini percutaneous nephrolithotomy in horseshoe kidney. Arch Ital Urol Androl 2023; 95:11605. [PMID: 37791551 DOI: 10.4081/aiua.2023.11605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE The percutaneous nephrolithotomy (PCNL) in Horseshoe kidneys (HSK) is usually performed in the prone position, allowing entry through the upper pole and providing good access to the collecting system. However, in patients with normal kidney anatomy, the supine position is reliable and safe in most cases, but it is unknown whether the supine position is adequate in patients with HSK. The purpose of this study was to describe the results of PCNL in HSK in three different surgical institutions and to evaluate the impact of supine position during surgery, comparing pre-operative and post-operative data, complications, and stone status after surgery. MATERIAL AND METHODS Between 2017 and 2022, a total of 10 patients underwent percutaneous renal surgery for stone disease in HSK. All patients were evaluated pre- and post- operatively with non-contrast CT. we evaluated patients (age and gender), stones characteristics (size, number, side, site and density ), and outcomes. The change in haemoglobin, hematocrit, creatinine and eGFr were assessed between the most recent preoperative period and the first postoperative day. Procedure success was defined as stone-free or presence of ≤4 mm fragments (Clinically Insignificant residual Fragments - CIrF). Complications were registered and classified according to Clavien-dindo Grading System, during the 30 - day postoperative period and Clavien scores ≥ 3 were considered as major complications. Statistical analysis was performed using "r 4.2.1" software, with a 5% significance level. we also compared pre-operative and post-operative data using "wilcoxon signedrank test". RESULTS No statistical difference was observed between preoperative and post-operative renal function data. At one post operative day CT scan, an overall success rate of 100% was registered. 9/10 patients were completely free from urolithiasis (stone-free rate: 90%), while 1/10 patients had ≤4 mm residual stone fragments (CIrF rate: 10%). No cases of intraoperative complications were registered. Post-operative complications were reported in 1/10 patients. A patient developed urosepsis (defined as SIrS with clinical signs of bacterial infections involving urogenital organs - Clavien-dindo Grade II) after procedure, and was treated with intravenous antibiotic therapy successfully. Conclusions: This study shows that in patients with HSK mini- PCNL in supine position allows to achieve good stone free rate with a very low morbidity. According to our series, the described technique for PCNL in HSK should be an option. Nevertheless these results must be confirmed by further studies.
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Affiliation(s)
- Orazio Maugeri
- Urology Section, Department of Surgery, University of Catania.
| | - Eugenio Di Grazia
- Endourology Unit, Casa di Cura Villa Azzurra, Siracusa; Endourology Unit, Casa di Cura Mater Dei, Catania.
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Han X, Han M, Li J. The annual-ring sign of calculus in the setting of horseshoe kidney. Am J Med Sci 2023; 366:e71. [PMID: 37295557 DOI: 10.1016/j.amjms.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/30/2022] [Accepted: 04/17/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Xiao Han
- School of Medical Imaging, Binzhou Medical University, Yantai, Shandong, China
| | - Mingxing Han
- School of Medical Imaging, Binzhou Medical University, Yantai, Shandong, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China.
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Roshandel MR, Lohse CM, Sharma V, Thompson RH, Boorjian SA, Leibovich BC. Implications of Tumor Surgery in Horseshoe Kidneys: A Comparative Study of Outcomes and Surgical Practices. Urology 2023; 179:87-94. [PMID: 37331487 DOI: 10.1016/j.urology.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To contrast surgical outcomes of Horseshoe Kidney (HSK) patients with localized renal masses suspected of cancer with nonfused nonectopic kidney patients, emphasizing safe surgical practices for HSKs. METHODS The study examined solid tumors from the Mayo Clinic Nephrectomy registry between 1971 and 2021. Each HSK case was matched to three non-HSK patients based on various factors. The outcomes measured included complications within 30days of surgery, change in estimated glomerular filtration rate, and overall, cancer-specific, and metastasis-free survival rates. RESULTS Thirty of the 34 HSKs had malignant tumors compared with 90 of the 102 patients in the nonfused nonectopic referent cohort. Accessory isthmus arteries were present in 93% of HSK cases, with 43% exhibiting multiple arteries and 7% with 6 or more arteries. Estimated blood loss and surgery duration were significantly higher in HSKs (900 vs 300 mL, P = .004; 246 vs 163 minutes, P < .001, respectively). The HSK group demonstrated an overall complication rate of 26% (vs 17% in referents, P = .2) and a median change in estimated glomerular filtration rate at 3months of - 8.5 (vs -8.1 in referents, P = .8). At 5-year follow-up, survival rates for HSK patients were 72%, 91%, and 69% for overall, cancer-specific, and metastasis-free survival, respectively. The corresponding rates were 79%, 86%, and 77%, respectively, for matched referent patients (P > .05). CONCLUSION HSK tumor management is technically challenging with higher blood loss; however, the data demonstrate comparable outcomes for patients with HSK tumors, including complications and survival, to those without HSKs in experienced centers.
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Affiliation(s)
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
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Corrales M, Sierra A. Retrograde intrarenal surgery for stones associated with renal anomalies: caliceal diverticulum, horseshoe kidney, medullary sponge kidney, megacalycosis, pelvic kidney, uretero-pelvic junction obstruction. Curr Opin Urol 2023; 33:318-323. [PMID: 37014757 DOI: 10.1097/mou.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
PURPOSE OF REVIEW Nowadays, due to the increase of imaging diagnosis, we identify easily renal anomalies, and we can choose between a wide range of armamentarium to treat symptomatic stones in those challenging cases. However, there is a lack of evidence and consensus on its use. The aim of this narrative review is to collect all the available data about safety and efficacity of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones associated to a renal anomaly. RECENT FINDINGS Renal anomalies are uncommon findings and even more if it has to be associated with renal stones. After a literature review of the past 2 years, there are a small number of studies that compare the outcomes in patients who have been treated with minimally invasive modalities and they are mainly focus on RIRS. SUMMARY It is of extreme importance to know the advances on the stone treatment in anomalous kidneys. With the development of new laser technologies, RIRS is becoming a more interesting technique with high success rate and safety. Further studies are needed to make an accurate statement about the adequate surgical technique for each renal anomaly and also, clinical trials using new laser technologies.
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Affiliation(s)
- Mariela Corrales
- Sorbonne University GRC Urolithiasis no. 20 Tenon Hospital Sorbonne University, Department of Urology AP-HP, Tenon Hospital, Paris, France
| | - Alba Sierra
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
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14
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Gembillo G, Bellinghieri G, Savica V, Santoro D. Horseshoe Kidney: 500 Years From the First Report in the Literature. EXP CLIN TRANSPLANT 2023; 21:49-52. [PMID: 37496344 DOI: 10.6002/ect.iahncongress.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Horseshoe kidney or ren arcuatus is the most common renal fusion anomaly, with an incidence of 1:500 in the normal population and a male predominance of 2:1. In >90% of cases, the fusion occurs along the inferior pole. It may vary in location, orientation, and arterial and venous anatomy. In 1522, Berengario da Carpi described this renal malformation for the first time in his masterpiece "Isagogae breves" (Introduction to Anatomy). He reported the results of a postmortem examination in the public autopsy room of the University of Bologna, describing "kidneys that are continuous as if they were a kidney, with two emulsifying veins, two emulsifying arteries, two ureteral outlets." In 1564, Leonardo Botallo described and illustrated the features of this atypical anatomical representation, and later, in 1602, Leonard Doldius added further details by examining this anatomical feature during an autopsy. In 1761, Giovanni Battista Morgagni discussed this condition not only as a rare anatomical curiosity found only in necroscopy but also discussed its physiological aspect. In the nineteenth century, with the advent of renal surgery, the horseshoe kidney played a more important role in urological diagnosis and treatment, and its identification became more frequent. With the advent of pyelography, imaging reports of the horseshoe kidney allowed a more accurate representation of the anatomical variants, which was particularly useful in preoperative assessment and outcomes. Berengario da Carpi laid the foundation for a better knowledge of this anatomical anomaly. Five hundred years after the first report in the literature, relevant advances have been made in the management of complications associated with horseshoe kidney and in diagnosis, confirming the need to monitor individuals with this condition who are at higher risk of developing chronic kidney disease.
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Affiliation(s)
- Guido Gembillo
- From the Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Li D, Zhang W, Wang J, Wang A, Wu M, Wei Y. Nephron-sparing surgery for primary mucinous adenocarcinoma of renal pelvis in horseshoe kidney: A case report. Medicine (Baltimore) 2023; 102:e33410. [PMID: 36961136 PMCID: PMC10035991 DOI: 10.1097/md.0000000000033410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
RATIONALE Mucinous adenocarcinoma of the renal pelvis is extremely rare in malignancy of the renal pelvis, and <100 cases have been reported so far. However, horseshoe kidneys appear to be more prone to this mucinous gland metaplasia. Due to the lack of a specific diagnostic basis, it is difficult to confirm the diagnosis before surgery, which is easy to cause misdiagnosis. PATIENT CONCERNS We report a 64-year-old male patient who found a cystic mass in the left kidney during physical examination. CT examination showed a horseshoe kidney with a cystic mass 9.5 × 8.0 cm in front of the left kidney, lacking obvious diagnostic features. DIAGNOSIS It was misdiagnosed as cystic teratoma before the operation, and was diagnosed as mucinous adenocarcinoma of the renal pelvis through pathological examination after the operation. INTERVENTIONS Resection of the tumor by nephron-sparing surgery and postoperative chemotherapy. OUTCOMES No tumor recurrence was found at 6 years of follow-up. After 7 years, the patient had multiple metastases in the abdominal wall and peritoneum, and no tumor recurrence was found in the urinary system. The patient received chemotherapy again and survived well. LESSONS The prognosis of nephron-sparing tumor resection for MRAP is not significantly different from that of radical nephroureterectomy + bladder cuff excision. Because it can reduce the risk that patients can not tolerate follow-up chemotherapy due to abnormal renal function after surgery, which may be more beneficial in patients with kidney abnormalities or chronic disease.
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Affiliation(s)
- Dapeng Li
- Department of Urology, Rongcheng People’s Hospital, The Affiliated Hospital of Jining Medical University, Weihai, Shandong, China
| | - Wei Zhang
- Department of Urology, Rongcheng People’s Hospital, The Affiliated Hospital of Jining Medical University, Weihai, Shandong, China
| | - Jun Wang
- Department of Urology, Rongcheng People’s Hospital, The Affiliated Hospital of Jining Medical University, Weihai, Shandong, China
| | - An Wang
- Department of Urology, Rongcheng People’s Hospital, The Affiliated Hospital of Jining Medical University, Weihai, Shandong, China
| | - Mingming Wu
- Department of Urology, Rongcheng People’s Hospital, The Affiliated Hospital of Jining Medical University, Weihai, Shandong, China
| | - Yangguang Wei
- Department of Urology, Rongcheng People’s Hospital, The Affiliated Hospital of Jining Medical University, Weihai, Shandong, China
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Zhang Z, Wang H, Xiao Y, Zhang H, Huang Z. Laparoscopic nephron-sparing surgery for horseshoe kidney complicated with renal hemangioma: a case report and literature review. CEN Case Rep 2023; 12:23-26. [PMID: 35727421 PMCID: PMC9892300 DOI: 10.1007/s13730-022-00712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
In very rare cases, horseshoe kidney can present simultaneously with renal hemangioma. Nephron-sparing surgery (NSS) is a minimally invasive surgical procedure for horseshoe kidney with tumor, but it is difficult to operate and has not been reported. We report a 71-year-old female with imaging examination revealed an unexpected horseshoe kidney malformation and a cystic mass in the right kidney before her bladder cancer surgery. After one and a half years of follow-up, the mass was progressively enlarged, and was classified as Bosniak type III. After evaluating the anatomical structure around the lesion by 3D reconstruction computed tomography, she received cystoscopic right double J ureteral catheter placement combined with retroperitoneal laparoscopic partial nephrectomy of the right kidney. After a 3-month follow-up, no tumor recurrence was observed, with normal kidney function. Retroperitoneal laparoscopic NSS of horseshoe kidney with hemangioma is feasible and adequate preoperative 3D reconstruction imaging is the guarantee of safe and smooth operation.
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Affiliation(s)
- Zhenyu Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng, Beijing, 100730, China
| | - Hai Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng, Beijing, 100730, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Hui Zhang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zhongming Huang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng, Beijing, 100730, China.
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Yamashi S, Okamoto K, Kan M, Mouri S, Soumiya K, Seto D, Atagi Y, Nakanishi S, Yanagihara Y, Ninomiya I, Fujikata S, Ohoka H. [LAPAROSCOPIC LIVE DONOR NEPHRECTOMY WITH HORSESHOE KIDNEY: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2023; 114:21-25. [PMID: 38246622 DOI: 10.5980/jpnjurol.114.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
We performed laparoscopic live donor nephrectomy (LDN) on approximately 200 patients in Ehime Prefectural Center Hospital between 2003 and 2016. In 2016, a fifty-something woman who was a donor candidate for her husband was revealed to have a horseshoe kidney through contrast-enhanced computed tomography; other LDN procedures used a retroperitoneal approach, but this one used a transperitoneal approach since the latter approach allowed for a more favorable visual field. The left kidney was selected since renal scintigraphy showed equal bilateral renal function and renal arteries are simpler on the left side. The kidney was removed after the isthmus was successfully transected without ischemia. The opened calyx in the left kidney was sutured via bench surgery, and the kidney was transplanted to the recipient. Postoperative courses of both donor and recipient were good.
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Affiliation(s)
- Sadamu Yamashi
- The Department of Urology, Ehime Prefectural Central Hospital
| | - Kenjiro Okamoto
- The Department of Urology, Ehime Prefectural Central Hospital
| | - Masaharu Kan
- The Department of Urology, Ehime Prefectural Central Hospital
| | - Shinsuke Mouri
- The Department of Urology, Ehime Prefectural Central Hospital
| | - Kai Soumiya
- The Department of Urology, Ehime Prefectural Central Hospital
| | - Daisuke Seto
- The Department of Urology, Ehime Prefectural Central Hospital
| | - Yuichiro Atagi
- The Department of Urology, Ehime Prefectural Central Hospital
| | | | | | - Iku Ninomiya
- The Department of Urology, Ehime Prefectural Central Hospital
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Sutthatarn P, Gomez Quevedo O, Gleason J, Davidoff AM, Murphy AJ. Management of intravascular thrombus in cases of bilateral Wilms tumor or horseshoe kidney. J Pediatr Surg 2022; 57:166-173. [PMID: 34452755 DOI: 10.1016/j.jpedsurg.2021.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE To describe the oncologic and surgical management of bilateral Wilms tumor or Wilms tumor arising in a horseshoe kidney with intravenous tumor thrombus to help pediatric surgeons negotiate this rare and difficult anatomic circumstance. METHODS A single-institution, retrospective medical record review identified 4 cases of bilateral WT and one case of WT arising in a horseshoe kidney with intravenous tumor thrombus between 2009 and 2021. The presentation, imaging, chemotherapy regimen, intraoperative approach, and surgical and oncologic outcomes were reviewed for each of these patients. RESULTS All patients received a total of 12 weeks of neoadjuvant chemotherapy. In two patients, a staged approach to the bilateral tumors was undertaken with the first side being operated on after six weeks of therapy and the other side undergoing surgery after an additional six weeks of therapy. Of five patients, four underwent nephron-sparing surgery of all tumors and one underwent unilateral radical nephroureterectomy with contralateral nephron-sparing surgery. Tumor thrombectomy was performed in four of five cases; one patient demonstrated a complete response of the intravenous tumor thrombus to neoadjuvant chemotherapy and did not require thrombectomy. Three patients received adjuvant flank radiotherapy. Three patients developed medically managed stage II or III chronic kidney disease and no patient required renal replacement therapy or kidney transplant to date. CONCLUSION Nephron-sparing surgery is feasible and safe to perform in selected cases of bilateral Wilms tumor with intravascular thrombus by utilizing three-drug neoadjuvant chemotherapy, staged approaches to each kidney when appropriate, and detailed preoperative and/or intraoperative mapping of renal venous anatomy. Successful nephron-sparing surgery with tumor thrombectomy is dependent on a branched renal venous system or the presence of accessory renal veins. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Pattamon Sutthatarn
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States; Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Oswaldo Gomez Quevedo
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States
| | - Joesph Gleason
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States; Department of Urology, University of Tennessee Health Science Center, Memphis, TN 38105, United States
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, United States
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, United States.
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19
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Ozen A, Civelek I, Yigit G, Iscan HZ. Horseshoe Kidney in a Patient with Leriche Syndrome. J Coll Physicians Surg Pak 2022; 32:S41-S43. [PMID: 35633008 DOI: 10.29271/jcpsp.2022.supp1.s41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/08/2020] [Indexed: 06/15/2023]
Abstract
Horseshoe kidney (HSK) is one of the most common congenital renal fusion anomalies. Difficulties are encountered during surgery of aortic diseases associated with this anomaly. A 47-year male presented to the Outpatient Clinic with one-year history of intermittent claudication in 20 meters. He was diagnosed with Leriche syndrome and horseshoe kidney (HSK). The patient underwent aorto-bifemoral bypass surgery via transperitoneal approach. The proximal anastomosis was completed in an end-to-side fashion. The bifurcated graft was positioned posteriorly to the isthmus; and distal anastomoses were performed onto the common femoral arteries. He was discharged from the hospital on the eighth postoperative day without any complications. Key Words: Abdominal aorta, Surgery, Horseshoe kidney, Leriche syndrome.
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Affiliation(s)
- Anil Ozen
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Isa Civelek
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Gorkem Yigit
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Hakki Zafer Iscan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
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Abstract
Upper tract urothelial carcinoma represents a small proportion (5%-10%) of all urothelial cancers. Although there are several management options, in undifferentiated or high-risk cases, surgery in the form of nephroureterectomy is the gold standard. Horseshoe kidney is the most common congenital renal fusion anomaly affecting 1 in 400-600 patients. We present the case of a smoker in her mid-50s with an incidental finding of a papillary lesion in the right renal pelvis of her horseshoe kidney on CT scan. She went on to have endoscopic assessment confirming no other foci of disease. She was definitively managed with a robotic nephroureterectomy.
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Affiliation(s)
- Edward Ramez Latif
- Urology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Issam Ahmed
- Urology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Milan Thomas
- Urology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Ben Eddy
- Urology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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21
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Gupta S, Erickson LA. Primary Renal Well-Differentiated Neuroendocrine Tumor (Carcinoid) in a Horseshoe Kidney. Mayo Clin Proc 2021; 96:1687-1688. [PMID: 34088430 DOI: 10.1016/j.mayocp.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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22
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Pineda-Murillo J, Arellano-Cuadros JR, Torres-Aguilar J, Viveros-Contreras C, Sánchez-Bermeo AF, Pineda-Murillo EG, Hernández-León O. Lithiasis in a horseshoe kidney. ARCH ESP UROL 2021; 74:543-544. [PMID: 34080577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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23
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Molina Escudero R, Herranz Yagüe JA, Crespo Martínez L, Páez Borda Á. [Laparoscopic management of horseshoe kidney stones.]. ARCH ESP UROL 2020; 73:856-859. [PMID: 33144541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Horseshoe kidney is the most common renal fusion anomaly. Its peculiar anatomical characteristics increase the risk of lithiasis formation and always entails a surgical challenge for its treatment. MATERIAL AND METHODS We present the cases of men with horseshoe kidneys diagnosed by CT one case of alarge pyelic lithiasis with others of a smaller size in the calyces, and the other of a big solitary lithiasis in renal pelvis. RESULTS: We performed a laparoscopic pyelolitectomy to remove the pyelic lithiasis and we used a flexible cystoscope through a trocar to extract the calyceal stones. The postoperative period was uneventful without evidence of urinary leakage or residual lithiasis. CONCLUSIONS: The laparoscopic approach to lithiasisis a suitable alternative in especially complex cases such as horseshoe kidney. The use of a flexible cystoscope allows to navigate through the renal cavities and extract the lithiasis which cannot be accessed through laparoscopic instruments, improving the efficiency of this approach.
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Affiliation(s)
| | | | | | - Álvaro Páez Borda
- Servicio de Urología. Hospital Universitario de Fuenlabrada. Madrid. España
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24
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Kang N, Bornak A. Fenestrated Endovascular Aortic Aneurysm Repair for Type 2 Horseshoe Kidney Preservation. Eur J Vasc Endovasc Surg 2020; 61:295. [PMID: 33046386 DOI: 10.1016/j.ejvs.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/30/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
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25
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Tamaoka K, Ohtsuka M, Mikamori M, Saito T, Furukawa K, Suzuki Y, Imasato M, Kishi K, Tanemura M, Akamatsu H. [Single-Incision Laparoscopic Colectomy for Descending Colon Cancer in a Patient with a Horseshoe Kidney]. Gan To Kagaku Ryoho 2020; 47:301-303. [PMID: 32381969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 67-year-old woman presented with bloody stools to a local physician. Lower gastrointestinal endoscopy revealed a type 3 all-circumferential tumor at descending colon. She was diagnosed with descending colon cancer and referred to our hospital for surgery. Preoperative computed tomography(CT)revealed a horseshoe kidney. We performed single-incision laparoscopic colectomy for descending colon cancer(cT3cN0cM0, cStageⅡa)complicated by a horseshoe kidney. The surgery was performed safely without any additional injuries. In patients with horseshoe kidneys, abnormalities have been reported in the running of the blood vascular system and the renal pelvis and ureter systems. Thus, sufficient understanding of the anatomic abnormality by preoperative examinations, such as 3D-CT, is essential for performing surgery safely.
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Affiliation(s)
- Kohei Tamaoka
- Dept. of Gastroenterological Surgery, Osaka Police Hospital
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Abstract
RATIONALE Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date. PATIENT CONCERNS Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day. DIAGNOSES On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys. INTERVENTIONS Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief. OUTCOMES Two patients have been followed up and have no stones recurrence. LESSONS Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.
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Lomoro P, Simonetti I, Vinci G, Fichera V, Prevedoni Gorone MS. Pancake kidney, a rare and often misdiagnosed malformation: a case report and radiological differential diagnosis. J Ultrasound 2019; 22:207-213. [PMID: 30361920 PMCID: PMC6531527 DOI: 10.1007/s40477-018-0331-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/09/2018] [Indexed: 12/13/2022] Open
Abstract
Renal ectopia and fusion anomalies are Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT) that are usually incidentally detected and asymptomatic. Patients affected present a higher risk of complications like recurrent urinary tract infections or obstruction. Pancake kidney (PK) is one of the rarest types of renal anomaly with complete fusion of the superior, mild and inferior poles of both kidneys in the pelvic cavity. Each kidney has its own excretory system with two ureters that do not cross the midline. In the asymptomatic cases, a conservative approach should be performed. Surgical management may be needed when urological problems occur. PK is often associated with congenital anomalies of other organs. Ultrasound is the first line radiological examination for the diagnosis and the follow-up of kidney malformations. The main sonographic findings suggesting PK diagnosis are a large and lobulated renal mass consisting of two fused lateral lobes without an intervening septum located in the pelvic cavity. Each lobe usually has a separate pelvicalyceal system, the renal pelvis is anteriorly placed and the ureters are usually short and enter the bladder normally without crosses the midline. Ultrasonography gives useful information on the morphology and volume of the organ, and on its vascularization through the use of the Color- and Power-Doppler. Computer Tomography and Magnetic Resonance Urography are second level techniques used to confirm the diagnosis and to evaluate the presence of other abnormalities. The knowledge of the imaging findings and the anatomy of congenital renal malformations is important to avoid diagnostic pitfalls and misinterpretations. We report the case of a 14-years old female with PK who was misdiagnosed with a horseshoe kidney (HSK) during an abdominal ultrasound.
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Affiliation(s)
- P. Lomoro
- Department of Diagnostic Medicine, Institute of Radiology IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - I. Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - G. Vinci
- Department of Nephrology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - V. Fichera
- Department of Pediatrics, Anna Meyer Children’s University Hospital, Florence, Italy
| | - M. S. Prevedoni Gorone
- Department of Diagnostic and Interventional Radiology and Neuroradiology of IRCCS, San Matteo University Hospital Foundation, Pavia, Italy
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Yang QT, Hong YX, Hou GM, Zheng JH, Sui XX. Retroperitoneoscopic nephrectomy for a horseshoe kidney with hydronephrosis and inflammation: A case report. Medicine (Baltimore) 2019; 98:e15697. [PMID: 31145283 PMCID: PMC6709270 DOI: 10.1097/md.0000000000015697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE A horseshoe kidney is the most common congenital fusion abnormality in the kidney, occurring in approximately 1 in 400 live births. Several complications including renal malignancies, ureteropelvic junction obstruction, urolithiasis, vesicoureteral reflux, and hydronephrosis can occur in this patient population. PATIENT CONCERNS A 28-year-old woman was admitted to hospital because of chronic left low back pain. Microscopic hematuria was not seen. Computed tomography showed the horseshoe kidney and left hydronephrosis. DIAGNOSES On the basis of these findings and clinical manifestations, the final diagnosis was the horseshoe kidney with left renal hydronephrosis and inflammation. INTERVENTIONS A retroperitoneoscopic nephrectomy on the left kidney was performed. OUTCOMES Histopathological examination of the specimen confirmed massive dilatation of the pelvicaliceal system and chronic pyelonephritic inflammation. The patient was discharged on the 7th postoperative day with no complications and no back pain. She remained well at 3 months with normal activity and good cosmetic result. LESSONS Retroperitoneoscopic nephrectomy can be a safe and minimally invasive surgery for horseshoe kidney treatment.
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Affiliation(s)
- Qing-Tao Yang
- Department of Urology, the Second Affiliated Hospital of Shantou University Medical College
| | - Yu-xiang Hong
- Department of Urology, the Second Affiliated Hospital of Shantou University Medical College
| | - Gao-ming Hou
- Department of Urology, the Second Affiliated Hospital of Shantou University Medical College
| | - Jun-Hong Zheng
- Department of Urology, the Second Affiliated Hospital of Shantou University Medical College
| | - Xu-Xia Sui
- Laboratory of Pathogenic Biology, Shantou University Medical College, Shantou Guangdong, China
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Roider L, Abdelaziz A, Gaballah AH. CHARGE Syndrome with High Bifurcation of the Abdominal Aorta and a Horseshoe Kidney: A Case Report. J Vasc Interv Radiol 2018; 29:1288-1290.e1. [PMID: 30146198 DOI: 10.1016/j.jvir.2018.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Laura Roider
- School of Medicine, University Hospital, One Hospital Drive, Columbia, MO 65212
| | - Amr Abdelaziz
- Division of Radiology, University Hospital, One Hospital Drive, Columbia, MO 65212
| | - Ayman H Gaballah
- Division of Radiology, University Hospital, One Hospital Drive, Columbia, MO 65212; Division of Body Imaging, University Hospital, One Hospital Drive, Columbia, MO 65212
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Lo T, Chaudhuri A. Crossed Renal Fusion and an Abdominal Aortic Aneurysm with a Trifurcation. Eur J Vasc Endovasc Surg 2016; 52:55. [PMID: 27167060 DOI: 10.1016/j.ejvs.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
Affiliation(s)
- T Lo
- Bedford Hospital NHS Trust, Bedford, UK
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31
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Bozdogan E, Demir M, Konukoglu O, Karakas E. Reverse U-shaped horseshoe kidney accompanied by gibbus deformity and spina bifida. Jpn J Radiol 2016; 34:448-50. [PMID: 27114084 DOI: 10.1007/s11604-016-0536-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/13/2016] [Indexed: 11/26/2022]
Abstract
Horseshoe kidney (HSK) is the most common fusion anomaly of kidneys. Diagnosis of horseshoe kidneys is made by the demonstration of an isthmus or band of renal tissue between the lower poles of the kidneys. Connection between the upper poles of the kidneys is extremely rare. Several types of skeletal anomalies can be seen concomitantly with HSK. In our present case, where the patient was a 3-year-old male, the connection of renal tissue was located between the upper poles of the kidneys. Furthermore, there was an accompanying spina bifida and Gibbus deformity secondary to anterior hypoplasia of the T10 vertebral body.
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Affiliation(s)
- Erol Bozdogan
- Department of Radiology, Faculty of Medicine, Harran University, Yenisehir Campus, 63300, Şanlıurfa, Turkey.
| | - Mahmut Demir
- Department of Pediatry, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Osman Konukoglu
- Department of Radiology, Faculty of Medicine, Harran University, Yenisehir Campus, 63300, Şanlıurfa, Turkey
| | - Ekrem Karakas
- Department of Radiology, Faculty of Medicine, Harran University, Yenisehir Campus, 63300, Şanlıurfa, Turkey
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Yecies T, Turner Іi RM, Ferroni MC, Jacobs BL, Davies BJ. Partial and hemi-nephrectomy for renal malignancy in patients with horseshoe kidney. Can J Urol 2016; 23:8156-8159. [PMID: 26892057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Horseshoe kidney is the most common congenital renal fusion anomaly, with an estimated incidence of 1.7 to 2.5 cases per 1000 live births. In these patients, nephron-sparing surgical management of renal tumors may be complicated by abnormal renal location, aberrant vasculature, and the presence of a renal isthmus. We present the largest known series of patients with renal malignancy in horseshoe kidneys managed by partial or hemi-nephrectomy with associated outcomes. MATERIALS AND METHODS A retrospective review of our institution's electronic medical record was conducted to identify consecutive cases over an 11 year period. Pediatric patients and those who underwent surgery for benign indications were excluded from analysis. RESULTS Eight patients with horseshoe kidney who underwent partial or hemi-nephrectomy for renal malignancy were identified. Median tumor size was 6.0 cm (IQR 3.7 cm-9.5 cm). Six patients had clear cell renal cell carcinoma (RCC), 1 patient had papillary RCC, and 1 patient had a renal carcinoid tumor with concurrent adenocarcinoma. Median length of stay was 4 days (IQR 2-.5.5 days). Median perioperative change in eGFR was -6 mL/min/1.73² (IQR -2.6-8.6 mL/min/1.73m²). One patient developed postoperative urine leak requiring percutaneous drainage and ureteral stent placement. Median follow up was 38.5 months, with a cancer-specific survival of 87.5% and an overall survival of 62.5%. CONCLUSION Partial and hemi-nephrectomy for renal malignancy can safely be performed in patients with horseshoe kidney with acceptable operative and oncologic outcomes.
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Affiliation(s)
- Todd Yecies
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Blackburne AT, Rivera ME, Gettman MT, Patterson DE, Krambeck AE. Endoscopic Management of Urolithiasis in the Horseshoe Kidney. Urology 2016; 90:45-9. [PMID: 26772644 DOI: 10.1016/j.urology.2015.12.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess the endourologic outcomes of patients diagnosed with a horseshoe kidney (HK) and symptomatic urolithiasis. METHODS A retrospective review was performed of patients diagnosed with an HK who underwent endoscopic management from 2002 to present. RESULTS We identified 45 patients with 64 stone-bearing moieties who underwent 56 procedures, of which 31 (69%) were male. Mean age was 49.4 years (23-78) and mean stone size was 1.6 cm (0.2-5.7). Of the 64 moieties, 37 (58%) underwent percutaneous nephrolithotomy (PCNL), 25 (39%) underwent ureteroscopy (URS), and 2 (3%) underwent extracorporal shockwave lithotripsy (SWL). More than one access was utilized in 2 (5.7%) moieties undergoing PCNL. Additional procedures were required in 10 (28.5%) PCNL patients, of which 7 were URS, 2 were secondary PCNL, and 1 sandwich therapy with SWL and PCNL. Stone-free rate by moiety was 81.1% for PCNL, 84% for URS, and 50% for SWL. Postoperative complications occurred in 3 patients in the PCNL group, including readmission for pain and complicated urinary tract infection. With a mean follow-up of 20.5 months (range 0-118 months), stone recurrence was noted in 7 (16%) patients with a total of 11 events. Calcium oxalate was the most common stone type and 20/24 (83%) of patients with metabolic evaluations were found to have at least one abnormality. CONCLUSION After careful consideration of the anatomy, individuals with HK and symptomatic urolithiasis can be managed safely by a variety of endoscopic approaches with excellent outcomes; however, secondary procedures and recurrence are common.
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Hu CH, Li QL, Li HP, Fan SQ, Zhang HX, Liu XL, He Y, Huang M, Lu M, Wang SS, Wu F. Rare coexistence of mediastinal hepatoid adenocarcinoma, idiopathic azoospermia and horseshoe kidney: a case report and review of the literature. Int J Clin Exp Pathol 2015; 8:11741-11746. [PMID: 26617920 PMCID: PMC4637736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/29/2015] [Indexed: 06/05/2023]
Abstract
Hepatoid adenocarcinoma (HAC) is the term proposed for a special type of extrahepatic tumors, which is similar to the hepatocellular carcinoma (HCC) both in the histopathology and immunohistochemistry. HAC has been observed in the stomach, colon, pancreas, gall bladder, lung and female genital tract, but rarely in the mediastinum. Now we describe a case of a 28-year-old Chinese male with primary mediastinal HAC with lung and liver metastasis. In this patient, HAC was associated with horseshoe kidney and idiopathic nonobstructive azoospermia. It seemed derivation abnormalities during organogenesis in the embryo stage played a significant role in the pathogenesis of HAC, horseshoe kidney and idiopathic nonobstructive azoospermia. Even the pathogenesis was still unknown; it may merit consideration of HAC together with horseshoe kidney and idiopathic nonobstructive azoospermia as a syndrome rather than as a spectrum of coincidental diseases. Furthermore, we found the HAC is a neoplasm with unfavorable outcomes despite aggressive and multi-protocol strategies. The serum alpha fetoprotein (AFP) should be regarded as a useful marker for diagnostic purposes and therapeutic response evaluation of HAC.
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Affiliation(s)
- Chun-Hong Hu
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Qiu-Li Li
- Depatment of Neurology, The First People’s Hospital of Chenzhou, University of South China102 Luojiajing Road, Chenzhou 423000, China
| | - Hai-Peng Li
- Depatment of Neurology, The First People’s Hospital of Chenzhou, University of South China102 Luojiajing Road, Chenzhou 423000, China
| | - Song-Qing Fan
- Department of Pathology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Hai-Xia Zhang
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Xian-Ling Liu
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Yan He
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Ming Huang
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Min Lu
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Si-Si Wang
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
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Jain TK, Basher RK, Mittal BR, Bhatia A, Rao KLN. Follow-up (99m)Tc EC renal dynamic scintigraphy and DMSA-III SPECT/CT in unmasking a masqueraded case of Horseshoe kidney. Rev Esp Med Nucl Imagen Mol 2015; 34:387-9. [PMID: 26139030 DOI: 10.1016/j.remn.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/19/2022]
Abstract
Hydronephrosis is a common finding in urinary tract outflow obstruction. Chronically obstructed hydronephrotic system may be associated with parenchymal changes. Ultrasound, intravenous urography, micturating cysto-urethrogram and scintigraphy are commonly performed to evaluate the cause of obstruction. In childhood, pelviureteric junction obstruction is a common cause of the hydronephrosis. Hydronephrosis can also be present in horseshoe kidneys due to poor drainage. However, a large sized hydronephrotic cavity may obscure the finding of horseshoe kidney. A case was reported, and it was diagnosed as horseshoe kidney on follow-up renal dynamic scan and confirmed with the help of dimercaptosuccinic acid SPECT/CT.
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Affiliation(s)
- T K Jain
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
| | - R K Basher
- Department of Nuclear Medicine, PGIMER, Chandigarh, India.
| | - B R Mittal
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
| | - A Bhatia
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - K L N Rao
- Department of Paediatric Surgery, PGIMER, Chandigarh, India
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Caccetta F, Caroppo M, Musio F, Mudoni A, Accogli A, Zacheo MD, Burzo D, Bramato D, Carluccio G, Nuzzo V. [Horseshoe kidney: not a simple fusion anomaly]. G Ital Nefrol 2015; 32:gin/00218.4. [PMID: 26252260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The horseshoe kidney is a congenital anatomical defect of the kidney that occurs in 0,25% of the population and is generally characterized by the fusion of the lower poles of the two kidneys through an isthmus and to which may be associated with urogenital and renal vascular anomalies. Asymptomatic in 1/3 of the cases and, most of time, accidentally discovered during a radiological examination, promotes nephrolithiasis, ureteropelvic junction obstruction, hydronephrosis, vesicoureteral reflux and pyelonephritis. We report two cases of patients with kidney horseshoe, characterized by the abrupt onset of a septic state with oligo-anuric acute renal failure, electrolyte and acid-base abnormalities, rapid decay of the general conditions, with detection of nephrolithiasis, hydronephrosis and acute pyelonephritis and whose clinical management resulted in a significant and synergistic nefro-urology involvment. The kidney horseshoe not represent so only a simple fusion anomaly but rather an important anatomical condition that, once diagnosed, it would be worthy of a careful clinical, radiological and laboratory surveillance, in order to prevent the potential complications that may be also particularly severe.
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Chibane A, Benatta M, Sallami S, Terki F, Kabdi A, Lebrara H. Neoplasia in horseshoe kidney: A diagnostic and therapeutic dilemma. Tunis Med 2015; 93:332-334. [PMID: 26578057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Derbew M, Ketema E. PENILE AGENESIS WITH CROSSED FUSED RENAL ECTOPIA. Ethiop Med J 2015; 53:105-107. [PMID: 26591298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Penile agenesis is one of the rarest urogenital anomalies with only less than 100 cases reported worldwide so far. Only 3 cases have been reported from Africa and to our knowledge none has been reported from our country Ethiopia. Viability depends on associated anomalies. Urogenital anomalies are the most common associated ones accounting for 54% of cases. This case report is unusual presentation, which is the first reported case of penile agenesis associated with left to right, crossed fused renal ectopia.
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