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Puliatti S, Ferretti S, Peñaranda NR, Eissa A, Ticonosco M, Faveri AD, Carne CD, Wisz P, Ferrari R, Tosi G, Annino F, Bianchi G, Micali S. Applicability and feasibility of robot-assisted cystectomy and intracorporeal urinary diversion in a patient with right renal pelvic ectopia. Int Braz J Urol 2024; 50:227-228. [PMID: 38386794 PMCID: PMC10953599 DOI: 10.1590/s1677-5538.ibju.2023.0608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The ectopic pelvic kidney, a common renal anomaly, is often smaller and malformed, with a shorter and sometimes tortuous ureter (1). Muscle-invasive bladder cancer (MIBC), constituting 15-25% of bladder cancer cases (2), mandates radical cystectomy with a 50% 5-year survival rate (2). Despite the growing use of robot-assisted radical cystectomy (RARC) (3, 4), there is limited data on its application in ectopic kidneys. Only one RARC case has been reported (5), in contrast to numerous open radical cystectomies (1, 6) involving an ectopic kidney. PATIENT AND METHODS After being diagnosed with T2 high-grade urothelial carcinoma, the 66-year-old patient, previously treated with multiple transurethral resections and adjuvant BCG therapy, received neoadjuvant chemotherapy. Preoperative staging CT revealed a 2.6 x 2.2 cm bladder neoformation and an ectopic right pelvic kidney. RESULTS Using the da Vinci Surgical System, radical cystectomy with ileal conduit (sec Wallace II) and lymphadenectomy were performed. During the demolition phase, the shorter right ureter was dissected with care to avoid damage to the renal pedicle. The reconstructive phase included intracorporeal urinary diversion (ICUD) and uretero-ileal anastomosis, facilitated by the favorable position of the kidney. The 8-hour console surgery resulted in minimal blood loss. Discharged on day 16 due to COVID-19, the patient exhibited positive outcomes. A 2-month CT follow-up revealed no cancer recurrence, metastasis, hydronephrosis, and complete regression of the lymphocele. Imaging follow-up continues without postoperative adjuvant chemotherapy. CONCLUSION Robotic surgery with intracorporeal urinary diversion holds potential for right-sided pelvic kidney cases, but additional studies are necessary for validation.
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Affiliation(s)
- Stefano Puliatti
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
- University of Modena and Reggio EmiliaModenaItalyUniversity of Modena and Reggio Emilia, Modena, Italy;
| | - Stefania Ferretti
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
| | - Natali Rodriguez Peñaranda
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
| | - Ahmed Eissa
- Tanta UniversityFaculty of MedicineUrology DepartmentTantaEgyptUrology Department, Faculty of Medicine, Tanta University, Tanta, Egypt;
| | - Marco Ticonosco
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
- University of Modena and Reggio EmiliaModenaItalyUniversity of Modena and Reggio Emilia, Modena, Italy;
| | - Andrea De Faveri
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
- University of Modena and Reggio EmiliaModenaItalyUniversity of Modena and Reggio Emilia, Modena, Italy;
| | - Cosimo De Carne
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
| | - Pawel Wisz
- Orsi AcademyMelleBelgiumOrsi Academy, Melle, Belgium;
| | - Riccardo Ferrari
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
- University of Modena and Reggio EmiliaModenaItalyUniversity of Modena and Reggio Emilia, Modena, Italy;
| | - Greta Tosi
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
- University of Modena and Reggio EmiliaModenaItalyUniversity of Modena and Reggio Emilia, Modena, Italy;
| | - Filippo Annino
- Ospedale San DonatoUnit of UrologyArezzoItalyUnit of Urology, Ospedale San Donato, Arezzo, Italy
| | - Giampaolo Bianchi
- University of Modena and Reggio EmiliaModenaItalyUniversity of Modena and Reggio Emilia, Modena, Italy;
| | - Salvatore Micali
- Azienda Ospedaliero-Universitaria di ModenaDepartment of UrologyItalyDepartment of Urology, Azienda Ospedaliero-Universitaria di Modena, Italy;
- University of Modena and Reggio EmiliaModenaItalyUniversity of Modena and Reggio Emilia, Modena, Italy;
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Edamura K, Sadahira T, Hara J, Iwata T, Ando W, Horii S, Nagao K, Kobayashi A, Araki M. Feasibility of robot‑assisted radical cystectomy in a patient with an ectopic kidney: A case report. MEDICINE INTERNATIONAL 2022; 3:1. [PMID: 36699661 PMCID: PMC9829220 DOI: 10.3892/mi.2022.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
An ectopic kidney is a rare congenital defect in which the kidney does not migrate to its normal anatomical position. In the present study, a robot-assisted radical cystectomy and intracorporeal urinary diversion were performed for a patient with an ectopic kidney. The present study describes the case of a 72-year-old male patient who was diagnosed with a bladder tumor by magnetic resonance imaging and cystoscopy. A transurethral resection of the bladder tumor was performed. The pathological examination revealed an invasive urothelial carcinoma. Contrast-enhanced computed tomography revealed an ectopic left kidney in the upper pelvis. A robot-assisted radical cystectomy, extended lymph node dissection and intracorporeal urinary diversion were performed. On the whole, as demonstrated herein, a robot-assisted radical cystectomy with intracorporeal urinary diversion is a feasible approach for muscle-invasive bladder cancer complicated by an ectopic kidney.
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Affiliation(s)
- Kohei Edamura
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan,Correspondence to: Dr Kohei Edamura, Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Junya Hara
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takehiro Iwata
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Wataru Ando
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Satoshi Horii
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kentaro Nagao
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Asuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Gandhi K, Jaison J, Mantri E. Unilateral non-rotated left kidney with vascular and ureter variations in a cadaver: a unique case report with embryological and educational aspects. J Vasc Bras 2021; 20:e20200156. [PMID: 34630538 PMCID: PMC8483010 DOI: 10.1590/1677-5449.200156] [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: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022] Open
Abstract
The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.
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Affiliation(s)
- Kusum Gandhi
- All India Institute of Medical Science - AIIMS, Department of Anatomy, Bhopal, Madhya Pradesh, India
| | - Judith Jaison
- All India Institute of Medical Science - AIIMS, Department of Anatomy, Bhopal, Madhya Pradesh, India
| | - Eti Mantri
- All India Institute of Medical Science - AIIMS, Department of Anatomy, Bhopal, Madhya Pradesh, India
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Bilateral Malrotation and a Congenital Pelvic Kidney with Varied Vasculature and Altered Hilar Anatomy. Case Rep Med 2015; 2015:848949. [PMID: 26640492 PMCID: PMC4657075 DOI: 10.1155/2015/848949] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 09/26/2015] [Accepted: 10/05/2015] [Indexed: 11/17/2022] Open
Abstract
Variations of structure and position of the kidney along with variations of renal vessels are most frequently reported. Rotational variations form a rare entity that are not cited in most embryology textbooks. During an educational cadaveric dissection of a 42-year-old male, a complex picture of bilateral anatomical variants was encountered. Malrotation of both kidneys and a left lobulated ectopic kidney along with open hilum was observed. The left kidney showed a pelvic position in front of sacral promontory with three renal arteries retaining its embryological aortoiliac branches and two renal veins draining into right common iliac vein. These variations have an embryological base. Pelvic kidney with rotational variation though comparatively rare assumes great importance in view of present-day surgical procedures like laparoscopic radical nephrectomy, percutaneous nephrectomy, and renal transplantation.
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Hinata N, Suzuki R, Ishizawa A, Miyake H, Rodriguez-Vazquez JF, Murakami G, Fujisawa M. Fetal development of the mesonephric artery in humans with reference to replacement by the adrenal and renal arteries. Ann Anat 2015; 202:8-17. [PMID: 26335195 DOI: 10.1016/j.aanat.2015.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/02/2015] [Accepted: 07/13/2015] [Indexed: 12/24/2022]
Abstract
According to the classical ladder theory, the mesonephric arteries (MAs) have a segmental arrangement and persist after regression of the mesonephros, with some of these vessels becoming definitive renal arteries. To avoid interruption of blood flow, such a vascular switching would require an intermediate stage in which two or more segmental MAs are connected to a definitive renal artery. To examine developmental changes, especially changes in the segmental distribution of MAs, we studied serial paraffin sections of 26 human embryos (approximately 5-7 weeks). At 5-6 weeks, 1-2 pairs of MAs ran anterolaterally or laterally within each of the lower thoracic vertebral segments, while 2-5 pairs of MAs were present in each of the lumbar vertebral segments, but they were usually asymmetrical. The initial metanephros, extending along the aorta from the first lumbar to first sacral vertebra, had no arterial supply despite the presence of multiple MAs running immediately anterior to it. Depending on increased sizes of the adrenal and metanephros, the MAs were reduced in number and restricted in levels from the twelfth thoracic to the second lumbar vertebra. The elimination of MAs first became evident at a level of the major, inferior parts of the metanephros. Therefore, a hypothetical arterial ladder was lost before development of glomeruli in the metanephros. At 7 weeks, after complete elimination of MAs, a pair of symmetrical renal arteries appeared near the superior end of the metanephros. In conclusion, the MAs appear not to persist to become a definitive renal artery.
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Affiliation(s)
- Nobuyuki Hinata
- Department of Urology, Kobe University School of Medicine, Kobe, Japan.
| | - Ryoji Suzuki
- Department of Anatomy, Akita University Graduate School of Medicine, Akita, Japan
| | - Akimitsu Ishizawa
- Department of Anatomy, Akita University Graduate School of Medicine, Akita, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University School of Medicine, Kobe, Japan
| | | | - Gen Murakami
- Division of Internal Medicine, Iwamizawa Asuka Hospital, Iwamizawa, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University School of Medicine, Kobe, Japan
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