Laparoscopic assisted percutaneous nephrolithotomy in ectopic pelvic kidneys

Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review

INTRODUCTION

Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney.

MATERIAL AND METHODS

Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: "pelvic ectopic kidney", "ureterorenoscopy", "extracorporeal lithotripsy", "PCNL", "pyelolithotomy". We incluyed original articles, meta-analysis, review and case reports.

RESULTS

130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85%-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor.

CONCLUSION

Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach.

Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review

INTRODUCTION

Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney.

MATERIAL AND METHODS

Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: «pelvic ectopic kidney», «ureterorenoscopy», «extracorporeal lithotripsy», «PCNL», «pyelolithotomy». We included original articles, meta-analysis, review and case reports.

RESULTS

130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor.

CONCLUSION

Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach.

Chronic kidney disease and upper tract concerns after congenital and acquired urinary tract abnormalities: considerations for transition of care in teens and young adults

PURPOSE

To emphasize the burden that chronic kidney disease (CKD) and its complications place on overall health and well-being over the lifetime in individuals with congenital and acquired urinary tract abnormalities.

METHODS

Topic-based literature review was performed and professional opinion was obtained to describe the scope of medical challenges faced by both teens and adults and their health care providers in the context of congenital and acquired urinary tract abnormalities.

RESULTS

Challenges include accurate assessment of glomerular filtration rate; engaging for consistent surveillance of blood pressure, proteinuria, and medical complications of CKD that increase the risk of progression to end-stage renal disease and affect general health; achieving early referral to nephrology for better outcomes; managing renal complications within the unique limitations of lower urinary tract function; treating upper tract urolithiasis in the atypical urinary tract; and preparing for successful renal transplant.

CONCLUSION

In individuals with congenital or acquired abnormalities of the urinary tract, there is an inherent risk of CKD with its associated morbidity and increased mortality risk. Interplay between the upper and lower urinary tract impacts CKD progression. Collaborative management between urology and nephrology is highly recommended to address the unique challenges for each individual over the lifetime.

Laparoscopy-Assisted Transperitoneal Percutaneous Nephrolithotomy for the Treatment of Renal Stones in a Horseshoe Kidney

The objective of this case report is to highlight treatment by LAT-PCNL in a patient with horseshoe kidney. A 51-year-man with hematuria presented to the emergency department with moderate abdominal pain starting 7 hrs ago. He did not report a history of previous urological disease. Renal stone and horseshoe kidney malformation were diagnosed based on the plain abdominal film, intravenous urogram (IVU), non-contrast computed tomography (CT-IVU), and ultrasound findings. Due to the larger stone bulk and renal malformation, it was not possible to perform extracorporeal shock wave lithotripsy (ESWL) monotherapy or ESWL sandwich therapy. Moreover, since percutaneous nephrolithotomy (PCNL) had some challenges and limitations due to high skin-to-stone distance, special anatomy, dispersion stones, and possible consequent internal organs injuries, we performed LAT-PCNL on our patient. We did not observe any perioperative complication. Postoperative control abdominal x-ray revealed only a medium ureteral stone that was extracted while removing the Double-J stent a month later. The patient was discharged on the third postoperative day with normal laboratory values. At 3-month follow-up, the patient was stone-free with normal renal function and renal ultrasonography. Laparoscopy-assisted transperitoneal PCNL seems to be a safe and minimally invasive technique that can be used as an alternative approach in the management of renal stones in special cases of horseshoe kidneys.

Laparoscopic Assisted Transmesocolonic Percutaneous Nephrolithotripsy in Ectopic Iliac Kidney

We report a case of 15-year old female who presented with recurrent lower abdominal pain treated three times with ESWL previously. She was diagnosed as having right ectopic kidney with a 4 cm renal stone in renal pelvis and involving lower and mid calyx. She was treated successfully with laparoscopic assisted transmesocolonic percutaneous nephrolithotripsy. Procedure resulted in complete stone clearance without any perioperative or post operative complication. Patient stayed in hospital for 72 h with no drains or stents after day 5, post operatively.

Microperc for the management of renal calculi in pelvic ectopic kidneys

Management of stone disease in an ectopic kidney is challenging. Laparoscopy or ultrasound guided percutaneous nephrolithotomy and retrograde intra-renal surgery are the preferred techniques for these stones. We performed ultrasound guided microperc using a 16 G needle for the management of renal calculi in pelvic ectopic kidneys in two patients. There was no intraoperative or post-operative complication. Both patients had complete stone clearance and were discharged on the first post-operative day. Ultrasound guided microperc is a safe and effective option for the management of small renal calculi in pelvic ectopic kidneys.

The emerging role of robotics and laparoscopy in stone disease

The surgical management of urolithiasis has undergone a remarkable clinical evolution over the past three decades. The once common practice of open stone surgery has nearly been relegated to historical interest by modern technology. The introduction of minimally invasive techniques, laparoscopy and robot-assisted surgery, have emerged to complete the urologist's armamentarium. The benefits to patients when other endourologic procedures have failed include less pain, shorter hospitalization and convalescence, and improved cosmesis. This chapter explores the historical shift from open to minimally invasive management for stone disease and the unique risks and outcomes associated with these procedures in modern urology.

Indication to open anatrophic nephrolithotomy in the twenty-first century: a case report

Introduction. Advances in endourology have greatly reduced indications to open surgery in the treatment of staghorn kidney stones. Nevertheless in our experience, open surgery still represents the treatment of choice in rare cases. Case Report. A 71-year-old morbidly obese female patient complaining about occasional left flank pain, and recurrent cystitis for many years, presented bilateral staghorn kidney stones. Comorbidities were obesity (BMI 36.2), hypertension, type II diabetes, and chronic obstructive pulmunary disease (COPD) hyperlipidemia. Due to these comorbidities, endoscopic and laparoscopic approaches were not indicated. We offered the patient staged open anatrophic nephrolithotomy. Results. Operative time was 180 minutes. Blood loss was 500 cc. requiring one unit of packed red blood cells. Hospital stay was 7 days. The renal function was unaffected based on preoperative and postoperative serum creatinine levels. Stone-free status of the left kidney was confirmed after surgery with CT scan. Conclusions. Open surgery can represent a valid alterative in the treatment of staghorn kidney stones of very selected cases. A discussion of the current indications in the twenty-first century is presented.

Management of colon injury after percutaneous renal surgery

Percutaneous access to the kidney has gained widespread use during the last decades. Iatrogenic colon injury is an uncommon but serious complication. Diagnosis is sometimes delayed, and treatment strategies are still controversial, including conservative management, colostomy, or primary repair. The aim of this review is to identify optimal diagnostic and treatment options for such injuries.