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Alsaikhan B, Abugamza F, Almuhanna A, Bakarmom M, Alhussaini S, Hajek D. Duplex Kidney in Adults: a Systematic Review of the Literature. Curr Urol Rep 2023; 24:591-600. [PMID: 37943428 DOI: 10.1007/s11934-023-01190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE OF REVIEW In this study, we describe a rare case of a male with a duplex renal collecting system with ectopic ureter insertion into the prostate who presented with sepsis and required urgent laparoscopic radical nephrectomy. This study offers urologists and emergency care practitioners a great overview of the variety of manifestations, anatomic differences, and therapeutic approaches for similar patients. RECENT FINDINGS modified reconstructive strategy could be a method of choice when addressing particular anatomies, such as incomplete duplex kidneys with ureteropelvic junction obstruction in both upper and lower poles when the obstruction is close to the confluence of the two ureters. There is a spectrum of acute presentations and management strategies in adult patients with duplex collecting systems. The majority of patients presenting with obstruction and infection are managed surgically with hemi-nephrectomy; stable patients who present with less extensive anomalies were managed conservatively or with ureteral dilatation or deroofing.
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Affiliation(s)
- Bader Alsaikhan
- Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Faisal Abugamza
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Almuhanna
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Bakarmom
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Alhussaini
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - David Hajek
- Division of Urology, Department of Surgery, North York General Hospital, Toronto, ON, Canada
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Chen CT, Wang SF. A Case of Left Duplex Kidney with Hydronephrosis Mimicking a Left Renal Cyst in a 29-Year-Old Woman. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927430. [PMID: 33221811 PMCID: PMC7690329 DOI: 10.12659/ajcr.927430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patient: Female, 29-year-old Final Diagnosis: Left duplicated kidney with upper moiety severe hydronephrosis Symptoms: Left side abdominal pain Medication: — Clinical Procedure: Robot-assisted left heminephrectom Specialty: Surgery • Urology
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Affiliation(s)
- Chung-Tso Chen
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Shih-Feng Wang
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
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Qin J, Wang P, Jing T, Kong D, Ye S, Xia D, Wang S. Retroperitoneal robot-assisted laparoscopic upper pole heminephrectomy in adult patients with duplex kidneys. Ther Clin Risk Manag 2019; 15:727-731. [PMID: 31354280 PMCID: PMC6572707 DOI: 10.2147/tcrm.s202454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background: To report our experience with retroperitoneal robot-assisted laparoscopic upper pole heminephrectomy in adult patients with duplex kidneys. Methods: We retrospectively reviewed the medical records of 7 patients who underwent retroperitoneal robot-assisted laparoscopic upper pole heminephrectomy at our institution between September 2014 and July 2017. Of the robot-assisted laparoscopic procedures, 5 were on the left and 2 on the right side. Results: All patients underwent robot-assisted laparoscopic surgery successfully in a totally retroperitoneal manner without conversion to open surgery. The mean operative time was 175 mins (range 140-270). The mean estimated blood loss was 84 mL (range 20-200). The mean postoperative hospital stay was 7 days (range 5-9). No major intraoperative and postoperative complications occurred. All patients had a resolution of their presenting symptoms after surgery at a mean follow-up of 24 months (range 14-38). Conclusion: Our initial clinical experience suggests that robot-assisted laparoscopic upper pole heminephrectomy using a retroperitoneal approach for a duplex kidney appears to be safe with acceptable perioperative outcomes.
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Affiliation(s)
- Jie Qin
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Ping Wang
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Taile Jing
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Debo Kong
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Sunyi Ye
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Dan Xia
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shuo Wang
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
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Yu S, Hu H, Ding G. Robot-Assisted Laparoscopic Left Renal Vein Transposition for the Treatment of Nutcracker Syndrome: A Preliminary Experience. Ann Vasc Surg 2019; 57:69-74. [PMID: 30684632 DOI: 10.1016/j.avsg.2018.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to describe our robot-assisted laparoscopic left renal vein (LRV) transposition experiences for nutcracker syndrome treatment. METHODS From August 2016 through May 2017, three patients with nutcracker syndrome underwent robot-assisted laparoscopic LRV transpositions. The patient demographics, surgical outcomes, and postoperative morbidities were reviewed. RESULTS Successful surgical procedures were performed in all three patients. The operative times for the three cases were 150, 175, and 162 minutes, respectively, while the LRV anastomosis times were 19, 22, and 13 minutes, respectively. No major perioperative complications were encountered, and the hematuria and flank pain were resolved in all three cases. At the 6-month follow-up, the computed tomography scan showed that the LRV narrowing had disappeared in two of the patients. Although one patient still exhibited LRV flattening, his symptoms were also relieved, and the varicose tributaries spontaneously ceased. CONCLUSIONS Robot-assisted laparoscopic LRV transposition can be a viable minimally invasive treatment option for patients with nutcracker syndrome.
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Affiliation(s)
- Shicheng Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China
| | - Haiyi Hu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China
| | - Guoqing Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China.
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Varda BK, Rajender A, Yu RN, Lee RS. A contemporary single-institution retrospective cohort study comparing perioperative outcomes between robotic and open partial nephrectomy for poorly functioning renal moieties in children with duplex collecting systems. J Pediatr Urol 2018; 14:549.e1-549.e8. [PMID: 30172696 DOI: 10.1016/j.jpurol.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/04/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Studies evaluating robotic-assisted laparoscopic partial nephrectomy (RALPN) are limited to case series, amounting to a lack of studies directly comparing perioperative outcomes for RALPN to open partial nephrectomy (OPN). OBJECTIVE To compare perioperative outcomes between RALPN and OPN. METHODS A single-institution, retrospective cohort study was performed to compare perioperative outcomes (operative time (OT), length of stay (LOS), complications, readmissions, postoperative interventions, loss in size of the residual moiety, and the presence of postoperative 'contained fluid collections') for RALPN and OPN between February 2007 and July 2014. Descriptive statistics were calculated and unadjusted analyses performed, including Chi-squared/Fisher's exact for categorical variables and Wilcoxon rank sum for continuous variables. RESULTS During the study period, 43 partial nephrectomies were performed for benign disease: 27 (63%) RALPN and 16 (37%) OPN. The RALPN cohort was significantly older than the OPN cohort (3.5 vs. 0.8 years; P = 0.003). The cohorts were otherwise similar regarding race, American Society of Anesthesiologist score (ASA), affected moiety, laterality, associated anomalies, moiety function, and surgical indication. Robotic-assisted laparoscopic partial nephrectomy was associated with a significantly shorter LOS (1 vs. 3 days; P = 0.002). Operative time and complication rates were comparable. The OPN group had a longer median follow-up (2.7 years vs. 1.1; P = 0.03). No differences were observed between the cohorts for readmissions, postoperative interventions, loss in size of residual moiety, or development of 'contained fluid collections'. These outcomes are reported in the Summary Table. 'Contained fluid collections' occurred more frequently after lower pole resections (73% vs. 30%; P = 0.009). DISCUSSION This study is one of the few to directly compare RALPN to OPN, and demonstrated that RALPN has comparable (if not better) outcomes than OPN. In particular, RALPN provides the advantage of a shorter LOS. Avoiding the flank incision used in OPN may also offer reduced pain; however, this was not studied here and the literature provides weak evidence for this effect. This unadjusted analysis may have been confounded by its short median follow-up and significantly younger OPN cohort. CONCLUSION In this contemporary comparative analysis, RALPN predicted a similar median OT and safety profile to OPN while offering the advantage of a shorter LOS. Regardless of surgical cohort, there were no adverse effects on the residual renal moieties and postoperative 'contained fluid collections' occurred with notable frequency and were independently associated with lower pole pathology.
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Affiliation(s)
- B K Varda
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
| | - A Rajender
- Department of Urology, Boston Medical Center, Boston, MA, USA
| | - R N Yu
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - R S Lee
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
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González J, Cózar JM, Gómez A, Fernández-Pérez C, Esteban M. Nephron-sparing surgery in renal cell carcinoma: current perspectives on technical issues. Curr Urol Rep 2016; 16:6. [PMID: 25633842 DOI: 10.1007/s11934-014-0475-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Surgical resection remains the standard treatment for renal cell carcinoma. Although historically the concept of wide excision of the affected kidney dictated surgical thinking for more than half a century, a better understanding of the biology of this tumor, standardized staging, and changing patterns of presentation permit today a refined management approach with nephron-sparing surgery, thus limiting potential long-term morbidity by maximizing the preservation of functional renal parenchyma. This paper aims to review the current status of nephron-sparing surgery for solid renal masses with an emphasis on indications, preoperative assessment, and operative technical issues, summarizing the most recent existing data on the subject.
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Affiliation(s)
- Javier González
- Servicio de Urología, Hospital Central de la Cruz Roja San José y Santa Adela Madrid, Avda. de Reina Victoria 22-26, 28003, Madrid, Spain,
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Percutaneous Cryoablation for Successful Treatment of a Persistent Urine Leak after Robotic-Assisted Partial Nephrectomy. J Vasc Interv Radiol 2015; 26:1867-70. [DOI: 10.1016/j.jvir.2015.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/25/2015] [Accepted: 08/28/2015] [Indexed: 11/18/2022] Open
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Yoshida K, Kinoshita H, Hayami Y, Nakamoto T, Takayasu K, Sugi M, Matsuda T. Laparoscopic upper-pole heminephrectomy for duplicated renal collecting system with superselective artery clamping using virtual partial nephrectomy analysis of Synapse Vincent: A case report. Int J Urol 2015; 22:1075-7. [PMID: 26300298 DOI: 10.1111/iju.12897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/12/2015] [Indexed: 11/27/2022]
Abstract
A 22-year-old woman was diagnosed with a duplicated renal collecting system with hydronephrosis and parenchymal loss in the upper pole of the left kidney. She underwent laparoscopic left upper-pole nephrectomy. Although a complex hilar vascular anatomy was identified during the operation, preoperative three-dimensional computed tomographic reconstruction using a three-dimensional image analysis device (Synapse Vincent; Fuji Medical Systems, Tokyo, Japan) greatly helped to accurately identify the anatomical renal hilum. For further detail, virtual partial nephrectomy analysis using a Voronoi decomposition was used to visualize the area supplied by a selected arterial branch including the atrophic cleavage line. We controlled the bleeding with selective clamping and safely carried out upper-pole heminephrectomy according to the preoperative plan.
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Affiliation(s)
- Kenji Yoshida
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yutaro Hayami
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takahiro Nakamoto
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kenta Takayasu
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Motohiko Sugi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
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