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Tsaturyan A, Faitatziadis S, Peteinaris A, Adamou C, Pagonis K, Natsos A, Vrettos T, Liatsikos E, Kallidonis P. Non-papillary prone percutaneous nephrolithotomy for renal abnormalities: single-institution experience. World J Urol 2023; 41:581-587. [PMID: 36547678 DOI: 10.1007/s00345-022-04254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of non-papillary prone PCNL for the treatment of patients with renal abnormalities. METHODS An observational retrospective cohort study including PCNL cases of patients with renal abnormalities was performed. The following inclusion criteria were applied: renal stones > 1.5 cm with maximal diameter, anatomical malformations of affected kidney (malrotated kidneys, horseshoe kidneys and kidneys with complete duplicated systems, medullary sponge kidney), patients treated with standard (30Fr) PCNL or mini-PCNL (22Fr). The lithotripsy was performed using the Lithoclast Master or the Lithoclast® Trilogy (EMS Medical, Nyon, Switzerland). RESULTS Overall, 57 patients, 35 males, and 22 females with any renal malformation underwent non-papillary prone PCNL. Our study included 25 patients with horseshoe kidneys, 21 with malrotated kidneys, 9 with kidneys with duplicated pelvicalyceal systems and 2 with medullary sponge kidneys. The mean cumulative stone size was 36 ± 1.4 mm and most of the stones were in the lower calyceal group (36.9%) and in the pelvis (27.2%). The stone-free rate (SFR) was 84.2% and the mean hospitalization time was 2.7 ± 0.7 days. In total, postoperative complications were developed in six patients (10.5%), half of them presenting fever and the other half requiring blood transfusion (Grade II). CONCLUSION The PCNL is the method of choice for treating large stones in anomalous kidneys. The generally accepted panacea that only a papillary puncture is safe is questioned by our results. Based on our experience, a non-papillary puncture proved to be a safe and effective procedure.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece.
| | - Solon Faitatziadis
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Angelis Peteinaris
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Constantinos Adamou
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, 26500, Rio, Patras, Greece
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Wani M, Mohamed AHA, Brown G, Sriprasad S, Madaan S. Challenges and options for management of stones in anomalous kidneys: a review of current literature. Ther Adv Urol 2023; 15:17562872231217797. [PMID: 38146488 PMCID: PMC10749522 DOI: 10.1177/17562872231217797] [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: 06/15/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction Congenital anomalies of the kidney and urinary tract (CAKUT) represent a wide range of disorders that result from developmental abnormalities of the kidneys, urinary collecting tract, and lower urinary tract. There has been extensive development in approaches to the management of stones in normal kidneys with the advent of retrograde intra-renal surgeries (RIRS)/ureteroscopies, extracorporeal shock wave lithotripsy (ESWL) percutaneous nephrolithotomy (PCNL), and minimally invasive surgery (laparoscopy/robotics). However, the management of stones in CAKUT is not straightforward and is often challenging for urologists. There are no clear guidelines available to help navigate stone management in such patients. Materials and methods The aim of this literature review was to focus on stone management in anomalous kidneys. Most common abnormalities were considered. The studies were very heterogeneous with different approaches. The methodology involved evaluating studies looking into individual surgical approaches to the management of stones in these anomalous kidneys as well as looking at different approaches to stone management, in particular renal abnormality. Results We found RIRS is a feasible approach in most stones with sizes <20 mm and PCNL holds the upper hand in stones more than 20 mm. However, ESWL, laparoscopy, and robotics have their places in managing some of these cases. Conclusion We concluded that stones in anomalous kidneys can be challenging but can be managed safely. There is no straightforward answer to the right technique but rather the right planning based on the anatomy of the kidney in terms of vascularity and drainage, stone size and density, and expertise available.
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Affiliation(s)
- Mudassir Wani
- Department Of Urology, Cardiff, and Vale University Health Board, Cardiff, UK
- Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham, UK
| | - Ahmed Haider Abdalla Mohamed
- Department of Urology, Dartford, and Gravesham NHS Trust, Dartford, UK
- Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham, UK
| | - Gareth Brown
- Department of Urology, Royal Glamorgan Hospital, Rhondda Cynon Taff, UK
| | - Seshadri Sriprasad
- Department of Urology, Dartford, and Gravesham NHS Trust, Dartford, UK
- Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham, UK
| | - Sanjeev Madaan
- Department of Urology, Dartford, and Gravesham NHS Trust, Darent Valley Hospital, Darenth Wood Road, Dartford, DA2 8DA, UK
- Canterbury Christ Church University Faculty of Social and Applied Sciences, Chatham ME4 4UF, UK
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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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Houat AP, Guimarães CTS, Takahashi MS, Rodi GP, Gasparetto TPD, Blasbalg R, Velloni FG. Congenital Anomalies of the Upper Urinary Tract: A Comprehensive Review. Radiographics 2021; 41:462-486. [PMID: 33513074 DOI: 10.1148/rg.2021200078] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The upper urinary tract is the most common human system affected by congenital anomalies. Congenital anomalies of the kidneys and ureters comprise a wide spectrum of disorders ranging from simple variants with no clinical significance to complex anomalies that may lead to severe complications and end-stage renal disease. They may be classified as anomalies of renal form, which are subclassified as structural anomalies (eg, persistent fetal lobulation, hypertrophied column of Bertin, and dromedary hump) and fusion anomalies (eg, horseshoe kidney and pancake kidney); anomalies of renal position (eg, renal malrotation, simple renal ectopia, and crossed renal ectopia) and renal number (eg, renal agenesis and supernumerary kidney); and abnormalities in development of the urinary collecting system (eg, pyelocaliceal diverticulum, megacalycosis, ureteropelvic junction obstruction, duplex collecting system, megaureter, ectopic ureter, and ureterocele). US is usually the first imaging modality used because of its low cost, wide availability, and absence of ionizing radiation. Intravenous urography and voiding cystourethrography are also useful, mainly for characterization of the collecting system and vesicoureteral reflux. However, intravenous urography has been replaced by CT urography and MR urography. These imaging methods not only allow direct visualization of the collecting system but also demonstrate the function of the kidneys, the vascular anatomy, adjacent structures, and complications. Comprehension of congenital anomalies of the upper urinary tract is crucial for an accurate diagnosis and correct management. The authors discuss the spectrum of these anomalies, with emphasis on embryologic development, imaging findings, clinical manifestations, and complications. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Abdallah P Houat
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Cassia T S Guimarães
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Marcelo S Takahashi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Gustavo P Rodi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Taísa P D Gasparetto
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Roberto Blasbalg
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Fernanda G Velloni
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
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Living Donor Nephrectomy Using a Right Malrotated Kidney: A Case Report. Transplant Proc 2020; 53:1279-1280. [PMID: 33248723 DOI: 10.1016/j.transproceed.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022]
Abstract
A 46-year-old woman was approved as a living kidney donor in our center for paired donation working with the National Kidney Registry. The imaging revealed a malrotated right kidney with the hilum oriented cephalad. We selected that kidney for donation, and an uneventful laparoscopic donor nephrectomy was performed. To our knowledge, this is the first case of laparoscopic living donor nephrectomy using a sagittally malrotated kidney.
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Omorogbe A, Rosen DC, Chandhoke R, Bamberger J, Gupta M. Ultrasound-Guided Access in a Malrotated Kidney: Optimally Safe and Effective. J Endourol Case Rep 2020; 6:166-169. [DOI: 10.1089/cren.2019.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aisosa Omorogbe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel C. Rosen
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan Chandhoke
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Bamberger
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Tsai HY, Lee MH, Chen HC, Chen HC, Guh JY. Sagittally malrotated kidney: a case series of two patients. Surg Radiol Anat 2014; 37:551-3. [DOI: 10.1007/s00276-014-1376-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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