Is Laparoscopic Approach Safe for Ectopic Pelvic Kidneys?

Transperitoneal Laparoscopic Pyelolithotomy in Pelvic Ectopic Kidneys: Experience From a Northern Indian Tertiary Care Institution

Introduction The ectopic pelvic kidneys have a higher likelihood of developing renal stones due to urinary stasis caused by the abnormal position of the renal pelvis, altered course of the ureter, and kidney malrotation. This retrospective study highlights the safety, efficacy, and feasibility of performing transperitoneal laparoscopic pyelolithotomy in cases of pelvic ectopic kidney. Methodology The 15 patients with ectopic pelvic kidneys and nephrolithiasis underwent laparoscopic pyelolithotomy. The kidney was exposed either by moving the bowel or using a trans-mesocolic approach. A surgical procedure was performed to remove stones from the renal pelvis using laparoscopic forceps. Following the placement of a double J stent, the incision in the renal pelvis was closed. The procedure was completed after the intraperitoneal drain was inserted. Results A total of 15 patients underwent the transperitoneal laparoscopic pyelolithotomy procedure, with a male-to-female ratio of 3:2. The average age of the patients was 41 (25-58) years, while the average size of the stones was 3.8 cm. Additionally, seven (46.6%) patients had the presence of caliceal stones in conjunction with the pelvic stone. Out of the 15 patients, some had stones on the left side (n = 9, 60%), while others had stones on the right side (n = 6, 40%). The operation with an average duration was 125 minutes with a range of (90-190). Fourteen (93.3%) patients were found to be free of stones. A patient required extracorporeal shock wave lithotripsy (ESWL) to address a small caliceal residual stone measuring 8 mm. After just one session of ESWL, this stone was completely cleared. All stones were successfully removed, resulting in a 100% stone-free rate. Conclusions Laparoscopic pyelolithotomy is a highly effective and efficient procedure for treating large and numerous stones in the ectopic pelvic kidney. This method has a significant level of efficiency in removing stones with limited consequences.

Management of de novo nephrolithiasis after kidney transplantation: a comprehensive review from the European Renal Association CKD-MBD working group

The lifetime incidence of kidney stones is 6%-12% in the general population. Nephrolithiasis is a known cause of acute and chronic kidney injury, mediated via obstructive uropathy or crystal-induced nephropathy, and several modifiable and non-modifiable genetic and lifestyle causes have been described. Evidence for epidemiology and management of nephrolithiasis after kidney transplantation is limited by a low number of publications, small study sizes and short observational periods. Denervation of the kidney and ureter graft greatly reduces symptomatology of kidney stones in transplant recipients, which may contribute to a considerable underdiagnosis. Thus, reported prevalence rates of 1%-2% after kidney transplantation and the lack of adverse effects on allograft function and survival should be interpreted with caution. In this narrative review we summarize current state-of-the-art knowledge regarding epidemiology, clinical presentation, diagnosis, prevention and therapy of nephrolithiasis after kidney transplantation, including management of asymptomatic stone disease in kidney donors. Our aim is to strengthen clinical nephrologists who treat kidney transplant recipients in informed decision-making regarding management of kidney stones. Available evidence, supporting both surgical and medical treatment and prevention of kidney stones, is presented and critically discussed. The specific anatomy of the transplanted kidney and urinary tract requires deviation from established interventional approaches for nephrolithiasis in native kidneys. Also, pharmacological and lifestyle changes may need adaptation to the specific situation of kidney transplant recipients. Finally, we point out current knowledge gaps and the need for additional evidence from future studies.

Laparoscopic Approach for Reconstructive and Ablative Procedures in Ectopic Pelvic Kidneys: A Challenge in 8 Cases

Introduction and Objective: Laparoscopy is the most widely followed approach in ablative or reconstructive kidney surgeries. The aim of this study is to assess the utility and safety of laparoscopic approach in pelvic ectopic kidney surgeries. Methods: Between July 1, 2021 and June 30, 2022, 8 patients with pelvic kidneys; 4 with pelviureteric junction obstruction, 3 with pelvic stones, and 1 nonfunctioning kidney underwent laparoscopic pyeloplasty, pyelolithotomy, and nephrectomy, respectively. The records of all 8 patients were evaluated retrospectively for analyzing the operating time, blood loss, postoperative hospital stay, intra- and postoperative complications, surgical difficulty, and the success in completing the case laparoscopically. The patients were followed for at least 6 months to know the outcome. After pyeloplasty the improvement in function and drainage as well were recorded. Results: Of 8 cases, 6 (75%) were completed laparoscopically. One pyelolithotomy and 1 pyeloplasty patient were converted to open surgery. The median operative time was 180 (140-240) minutes, median blood loss was 100 (50-300) mL, and median hospital stay was 4 (3-6) days. One patient, who had open conversion, had Clavien grade I complication in the form of prolonged fever. Pyeloplasty patients at 6 months follow-up showed improvement in symptoms as well as function. Conclusion: The laparoscopic approach has obvious benefits in pelvic surgeries. Laparoscopy for ectopic pelvic kidneys are challenging due to abnormal anatomy of vessels and kidneys. Proper exposure of kidneys and exact identification of vessels can accomplish laparoscopic procedure in ectopic kidneys successfully with patients having nil complications and early convalescence.

Laparoscopic transmesocolic pyelolithotomy and pyeloplasty in an ectopic pelvic kidney: Case report and review of literature

Renal ectopia is a developmental anomaly with pelvic kidney being the commonest location (55%). The incidence of uretero-pelvis junction (UPJ) obstruction, nephrolithiasis, and reflux are higher in ectopic kidneys than their counterparts. We herein report a case of left ectopic pelvic kidney with large stone associated with UPJ narrowing managed successfully simultaneously with laparoscopic transmesocolic pyelolithotomy and pyeloplasty in a 45-year female. This is the largest stone reported in the literature in an ectopic pelvic kidney managed successfully with favorable outcome.

Minimally invasive treatment of an ectopic kidney stone: a case report and literature review

An ectopic pelvic kidney is a rare congenital anomaly with a high incidence of complications such as reflux, hydronephrosis, nephrolithiasis, and even renal failure. We herein report a case of transperitoneal laparoscopic pyelolithotomy for treatment of a left pelvic kidney stone and discuss various surgical procedures based on the published literature. A 64-year-old woman presented to our hospital with generalized weakness and occasional nonspecific waist pain in October 2017. Computed tomography showed a 2.6-cm renal pelvis stone located in the left ectopic pelvic kidney with severe hydronephrosis. The patient underwent transperitoneal laparoscopic pyelolithotomy and was discharged 7 days after surgery. Various treatment procedures are available for ectopic kidney stones. Proper preoperative assessment and selection of the most suitable surgical procedure play critical roles in successful treatment.

"Vaginal Delivery": A Novel Extraction Route for Large Renal Calculi Encountered During Laparoscopic Pyeloplasty

Background

To describe a simple, novel stone extraction technique using the transvaginal route for large renal calculi encountered during laparoscopic/robotic pyelolithotomy.

Methods

After a standard approach laparoscopic pyelolithotomy in a patient with a large (42 × 36 mm) pelvic calculus, Anderson-Hynes pyeloplasty was performed. A transverse posterior colpotomy was performed laparoscopically with the assistance of the Colpassist Vaginal Positioning Device (Boston Scientific) and the calculus was extracted, intact, through the vagina with the aid of an endoscopic retrieval bag. The vaginal incision was then closed intra-corporeally. A systematic review on the topic was also performed.

Results

The stone was removed in its entirety through an occult vaginal incision. There were no complications reported and the patient was stone free at follow-ups.

Conclusions

This simple, novel technique is an easily reproducible method, for the removal of large urinary calculi during either traditional laparoscopic or robotic-assisted laparoscopic stone surgery in the appropriate female patient. It avoids the need for additional abdominal incisions or complex techniques involving lithotripsy which may be more complicated and time consuming. All previously published stone extraction techniques for large calculi (greater than 20 mm) within this systematic review are also critically appraised.

Laparoscopic treatment of ureteropelvic junction obstruction in five pediatric cases of pelvic kidneys

OBJECTIVE

Ectopic kidney is a rare urologic condition and may be revealed by ureteropelvic junction obstruction (UPJO) in children, with pelvic kidney being the most common location. Our experience using a minimally invasive approach to treat UPJO by dismembered pyeloplasty led us to report five cases of UPJO with pelvic kidney operated on by transperitoneal laparoscopy, focusing on medium-term follow-up results and surgical technique.

PATIENTS AND METHODS

From 1999 to 2010, we reviewed all cases of UPJO managed in our center, a total of 391 patients. Among those, 125 patients were operated on via a minimal invasive approach, 104 by retroperitoneoscopy, and 21 by transperitoneal laparoscopy. Five patients presented ectopic pelvic kidney and were retrospectively reviewed. US-scan and uro-MRI were done preoperatively in all cases for anatomic and functional evaluation. Peri-operative data such as operative time, transfusion, and complications were reported. At last clinic, sonographic and functional evaluation was noted. Focusing on surgical technique, we reported the tips and tricks to successfully and easily perform the dismembered pyeloplasty: optimization of the trocars' location according to the kidney location and use of a transparietal stay stitch to stabilize the suture line of the pyeloplasty.

RESULTS

All five patients underwent dismembered pyeloplasty, at a mean age of 8 years and a mean weight of 23.4 kg. Mean operative time was 213 min (min-max: 180-245). One case of giant hydronephrosis and megacalicosis required conversion at the beginning of the learning curve. None of the patients required blood transfusion. Mean hospital stay was 2.4 days (range: 1-4). All the patients had an uneventful postoperative recovery and good postoperative functional results, with either stable or improved pelvic dilatation and renal function at a mean follow-up of 3.3 years (range: 2-5.6).

DISCUSSION

This small series of five ectopic kidneys reflects the surgical challenge for the pediatric surgeon to perform reconstructive surgery on an abnormal anatomy. However, increasing experience in robotics in urologic pediatric surgery may lead to shortening of operative time and facilitate both dissection and suturing.

CONCLUSION

Dismembered pyeloplasty by transperitoneal laparoscopy is a feasible although technically demanding, safe and effective approach in the management of ureteropelvic junction obstruction in pelvic kidney in children.

Scarless single-port laparoscopic pelvic kidney nephrectomy

INTRODUCTION

We report the first pelvic kidney removal through the umbilicus using a scarless pure single-port technique in a young woman.

PATIENTS AND METHODS

A 27-year-old woman presented with uro-sepsis and acute renal failure secondary to a dilated, chronically infected, nonfunctioning left-sided pelvic kidney with ureteropelvic obstruction causing an obstruction to the right kidney. The acute episode was managed with bilateral ureteric stents and antibiotics. Definitive treatment involved removal of the diseased pelvic kidney through the umbilicus via a single-port access device (TriPor™; Olympus). A curved tissue grasper and extralong bariatric suction device were used along with standard straight laparoscopic instruments. In addition, a 10-mm flexible-tip video laparoendoscope (HD EndoEYE LTF-VH™; Olympus) and a robotic camera holder (FreeHand™; Prosurgics) were used to reduce external instrument clash.

RESULTS

The procedure was technically successful leaving the patient with a scarless abdomen. The operative time was 185 minutes, blood loss 100 mL, and length of stay 48 hours. There were no complications.

CONCLUSION

Scarless transumbilical pelvic nephrectomy is technically feasible. The first reported clinical experience is discussed.

Laparoscopic renal surgery for benign disease

Fifteen years after the first report, laparoscopic nephrectomy has demonstrated proven efficacy and safety comparable with an open approach, with a significant advantage of a faster recovery. Wide dissemination of these surgical techniques and continued improvement in instrumentation has made laparoscopy the preferred approach for treating benign pathologic conditions of the kidney. In this review, the expanding indications of laparoscopic simple nephrectomy and the outcomes of the larger clinical series are examined. We discuss the technical aspects of both transperitoneal and retroperitoneal approaches. Finally, laparoscopic cyst decortication and some of the novel applications of laparoscopic renal surgery are highlighted.

Management of urolithiasis in the congenitally abnormal kidney (horseshoe and ectopic)

PURPOSE OF REVIEW

Urolithiasis in horseshoe and ectopic kidneys presents unique challenges in the decision-making and technical aspects of stone treatment. Specific renal anatomy, stone size and associated conditions such as ureteropelvic junction obstruction are factors that may influence treatment. Detailed review of imaging is important to ensure efficient stone treatment and minimize complications.

RECENT FINDINGS

Widespread use of extracorporeal shockwave lithotripsy for calculi in congenitally abnormal kidneys is now giving way to stone-size and anatomy-appropriate therapeutic decision making. Multiple modalities including shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and laparoscopy are being employed in this group of patients.

SUMMARY

Treatment decisions for stones in horseshoe and ectopic kidneys can be challenging, and must be made on an individual basis taking into account multiple variables.