Management of upper urinary tract calculi in crossed fused renal ectopic anomaly

The Discovery of an S-shaped Kidney in a Patient With Prostate Cancer: A Rare Finding

Crossed fused renal ectopia (CFRE) constitutes a rare congenital anomaly of the urinary tract, typically characterized by its predominantly asymptomatic nature and frequent incidental discovery. This case report delineates the clinical profile of a 56-year-old male admitted to our Prostate Cancer Outpatient Clinic due to elevated prostate-specific antigen (PSA) levels, ultimately leading to the diagnosis of prostate cancer. The patient was asymptomatic, with no family or surgical background. Notably, a fused ectopic kidney was incidentally identified during the staging process involving abdominal computed tomography (ACT) scanning. Remarkably, no additional abnormalities of the urinary tract or renal dysfunction manifested in this specific case. The significance of this report lies in the underscored emphasis on the importance of employing precise imaging techniques and tailored management strategies for patients harboring such anatomical variations.

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis

Objective

A case-control study was conducted to compare the efficacy and prognostic factors of flexible ureteroscopic lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) when treating complex upper urinary tract renal calculi based on a retrospective cohort study.

Methods

The study period was from October 2019 to December 2021. A retrospective study was carried out on 100 patients with complicated upper urinary tract nephrolithiasis who underwent surgery in the Urology Department of our hospital. They were assigned into two groups: FURL and PCNL groups. The intraoperative blood loss, operation time, hematuria duration, hospital stay, primary stone removal rate, incidence of intraoperative and postoperative complications, VAS score, level of inflammatory factors, and micturition function were compared. According to the postoperative prognosis, the patients were reassigned into two groups: good prognosis group (n = 38) and poor prognosis group (n = 106). The factors related to poor prognosis after FURL and PCNL were screened, and multivariate loglistic regression analysis was adopted to determine the risk factors.

Results

The primary stone clearance rate in the PCNL group was significantly higher than that in the FURL group, and there was no significant difference in the incidence of intraoperative and postoperative complications between the two groups (P > 0.05). The intraoperative blood loss and the duration of hematuria in the PCNL group were significantly shorter than those in the FURL group, and the operation time and postoperative hospital stay in the FURL group were longer than those in the FURL group. The postoperative VAS score in the study group was significantly lower than that in the control group (P < 0.05). The levels of CRP, IL-1, TNF-α, and NF-κB in both groups decreased after operation, and the level of inflammatory factors in the PCNL group was significantly lower than that in the FURL group (P < 0.05). The indexes of IPSS and Q max in the PCNL group were significantly lower than those in the control group 3 months after operation. The index of micturition function in the PCNL group was significantly lower than that in the FURL group. Preoperative use of immunosuppressant, preoperative stone fever, positive preoperative urine culture, preoperative urinary leukocyte count ≥ 544 × L, intraoperative urinary opacity, and pus fur were significantly correlated with poor prognosis of ureteral patients (P < 0.05). Preoperative stone fever, high preoperative urinary leukocyte count, intraoperative urinary turbidity, and suppurative fur were independent risk factors for postoperative SIRS in patients with ureteral calculi.

Conclusion

PCNL is effective when treating complex upper urinary tract renal calculi. Compared with FURL, PCNL can remarkably reduce intraoperative blood loss and hematuria duration, can enhance micturition function, and will not remarkably increase the incidence of intraoperative and postoperative complications, high safety. High white blood cell count in urine before operation, fever due to stone before operation, turbid urine, and purulent fur during operation are independent risk factors for postoperative adverse outcome in patients with complex upper urinary tract renal calculi. Patients should be fully treated before surgery.

Retrograde ureteroscopic lithotripsy in cross-fused renal ectopia

INTRODUCTION

Cross-fused renal ectopia is a rare congenital malformation, and few cases of urolithiasis have been treated by retrograde ureteroscopic lithotripsy. We report a case of urolithiasis in right-to-left and superior-type cross-fused renal ectopia, successfully treated by the retrograde approach.

CASE PRESENTATION

A 69-year-old woman with two 14-mm renal stones in cross-fused renal ectopia underwent retrograde ureteroscopic lithotripsy. Although we did not recognize the anomaly preoperatively, we could diagnose urolithiasis in the ectopic kidney intraoperatively. The patient had no complication, and follow-up computed tomography after 3 months showed only a 5-mm renal stone.

CONCLUSION

Although urolithiasis in patients with cross-fused renal ectopia is a challenging condition for the urologist, the retrograde approach is a safe and effective treatment method. It is necessary to carefully examine the urinary tract especially in a patient with a history of unidentified solitary kidney.

Minimally Invasive Approaches for Stone Clearance in Crossed Fused Renal Ectopia

Crossed fused renal ectopia (CFRE) is a rare fusion anomaly of the kidneys, with a predisposition to calculus disease. Management of renal calculi in CFRE is not standardized because of paucity of literature. We managed a 32-year-old man with left to right CFRE with multiple stones in both the kidneys by percutaneous nephrolithotomy for the right moiety and laparoscopic pyelolithotomy for the crossed moiety. Based on the stone burden and anatomy, we decided to go for a staged approach, to provide maximum clearance rate with least risk. We share our experience in this case, with regard to the use of two different but minimally invasive modalities for effective management of the patient. We also emphasize on the utilization of a staged approach whenever required for patient safety. We also reviewed the literature regarding the management of kidney stones in this rare anomaly.

Against the Odds: Management of Ureteral Calculus in Patient With Crossed Fused Renal Ectopia

Crossed fused renal ectopia (CFRE) is a rare congenital abnormality of the urinary tract where the kidneys are fused on one side, while the ureter of the ectopic kidney crosses the midline with the normal entrance in the bladder on the contralateral side. Congenital anomalies are associated with a stone formation whose management represents a real challenge. To our knowledge, we report the second case of CFRE associated with ureteral stone, which has been successfully resolved with Extracorporeal Shockwave Lithotripsy (ESWL) and the first of its kind where a sufficient degree of stone disintegration has been achieved after a single session with a complete stone clearance during the follow-up. Radiological examination showed an inferior type of CFRE with stone in the proximal part of the ureter of the upper kidney. ESWL is an acceptable and effective treatment option in CFRE patients due to the minimally invasive approach, potentially high stone-free rate, and rare complications.

Percutaneous Nephrolithotomy in a Patient with Cross-Fused Renal Ectopia

Background: Cross-fused renal ectopia (CFRE) is a rare congenital anomaly in which an ectopic kidney crosses the midline and merges with the orthotopic kidney on the other side. Patients with CFRE could present with urolithiasis. The abnormal anatomy and the lack of consensus to treat urolithiasis in these cases present challenges to treatment. In this study, we present a case of renal stone in a CFRE managed through percutaneous nephrolithotomy (PCNL). Case Presentation: We present a case of a 59-year-old man with right flank pain. Radiologic studies showed a 2 cm renal pelvis stone in a CFRE. The patient was effectively managed with PCNL. Conclusion: With proper radiologic study and thorough understanding of the aberrant anatomy, PCNL represents a safe and effective treatment for patients with renal stones in CFRE with high stone-free rate and low mortality.