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Uketa S, Shimizu Y, Yamaguchi R, Utsunomiya N, Kanamaru S. Robot-assisted partial nephrectomy via retroperitoneal approach in a patient with horseshoe kidney. IJU Case Rep 2021; 4:239-242. [PMID: 34258538 PMCID: PMC8255279 DOI: 10.1002/iju5.12297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Horseshoe kidney is a renal fusion anomaly often associated with ectopia, malformation, and vascular changes. Robot-assisted partial nephrectomy is selected for patients with T1a renal cell carcinoma; however, there are few reports of renal cell carcinoma in horseshoe kidney. We present a case of robot-assisted partial nephrectomy via a retroperitoneal approach in a patient with horseshoe kidney with a brief literature review. CASE PRESENTATION An 84-year-old woman presented with a 2-cm mass in horseshoe kidney. She underwent robot-assisted laparoscopic partial nephrectomy via a retroperitoneal approach. CONCLUSION The use of robot-assisted laparoscopic partial nephrectomy in patients with horseshoe kidney is very rare, and only four cases have been reported. Because of the unique anatomical structure, surgeons need to consider surgical strategy more carefully, considering tumor location, vascular anatomy, and past history of abdominal surgery.
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Affiliation(s)
- Shoko Uketa
- Department of UrologyKobe City Nishi‐Kobe Medical CenterKobeJapan
| | - Yousuke Shimizu
- Department of UrologyKobe City Nishi‐Kobe Medical CenterKobeJapan
| | | | | | - Sojun Kanamaru
- Department of UrologyKobe City Nishi‐Kobe Medical CenterKobeJapan
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Shao Z, Tan S, Yu X, Liu H, Jiang Y, Gao J. Laparoscopic nephron-sparing surgery for a tumor near the isthmus of a horseshoe kidney with a complicated blood supply. J Int Med Res 2021; 48:300060520926736. [PMID: 32489122 PMCID: PMC7273767 DOI: 10.1177/0300060520926736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A horseshoe kidney is a congenital kidney malformation commonly associated with
complications such as hydronephrosis, renal calculi, and infections of the renal pelvis.
Renal cell carcinoma is extremely rare in a horseshoe kidney; once it occurs, however, it
is intractable because of vascular abnormalities. This is especially true in laparoscopic
nephron-sparing surgery, even for tumors of <4 cm in diameter. We herein report a case
involving an asymptomatic 65-year-old man with an incidental finding of a 4-cm solid mass
near the isthmus of a horseshoe kidney on B-mode ultrasonography. Preoperative computed
tomography of the renal artery revealed six arterial vessels supplying the affected
kidney. Laparoscopic partial nephrectomy was performed. The outcome of this case suggests
that laparoscopic nephron-sparing surgery might be a successful treatment method for a
horseshoe kidney but that preoperative vessel evaluation and experienced laparoscopic
skills are needed.
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Affiliation(s)
- Zhiqiang Shao
- Department of Urology, the Linyi People's Hospital, Linyi, Shandong province, China
| | - Shanfeng Tan
- Department of Urology, the Linyi People's Hospital, Linyi, Shandong province, China
| | - Xiaohong Yu
- Department of Urology, the Linyi People's Hospital, Linyi, Shandong province, China
| | - Hongjun Liu
- Department of Urology, the Third Linyi People's Hospital, Linyi, Shandong province, China
| | - Yongjun Jiang
- Department of Urology, the Third Linyi People's Hospital, Linyi, Shandong province, China
| | - Jiangping Gao
- Department of Urology, the Fourth Medical Center of PLA General Hospital, Beijing, China
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Yang QT, Hong YX, Hou GM, Zheng JH, Sui XX. Retroperitoneoscopic nephrectomy for a horseshoe kidney with hydronephrosis and inflammation: A case report. Medicine (Baltimore) 2019; 98:e15697. [PMID: 31145283 PMCID: PMC6709270 DOI: 10.1097/md.0000000000015697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE A horseshoe kidney is the most common congenital fusion abnormality in the kidney, occurring in approximately 1 in 400 live births. Several complications including renal malignancies, ureteropelvic junction obstruction, urolithiasis, vesicoureteral reflux, and hydronephrosis can occur in this patient population. PATIENT CONCERNS A 28-year-old woman was admitted to hospital because of chronic left low back pain. Microscopic hematuria was not seen. Computed tomography showed the horseshoe kidney and left hydronephrosis. DIAGNOSES On the basis of these findings and clinical manifestations, the final diagnosis was the horseshoe kidney with left renal hydronephrosis and inflammation. INTERVENTIONS A retroperitoneoscopic nephrectomy on the left kidney was performed. OUTCOMES Histopathological examination of the specimen confirmed massive dilatation of the pelvicaliceal system and chronic pyelonephritic inflammation. The patient was discharged on the 7th postoperative day with no complications and no back pain. She remained well at 3 months with normal activity and good cosmetic result. LESSONS Retroperitoneoscopic nephrectomy can be a safe and minimally invasive surgery for horseshoe kidney treatment.
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Affiliation(s)
- Qing-Tao Yang
- Department of Urology, the Second Affiliated Hospital of Shantou University Medical College
| | - Yu-xiang Hong
- Department of Urology, the Second Affiliated Hospital of Shantou University Medical College
| | - Gao-ming Hou
- Department of Urology, the Second Affiliated Hospital of Shantou University Medical College
| | - Jun-Hong Zheng
- Department of Urology, the Second Affiliated Hospital of Shantou University Medical College
| | - Xu-Xia Sui
- Laboratory of Pathogenic Biology, Shantou University Medical College, Shantou Guangdong, China
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Agrawal S, Kalathia J, Chipde SS, Mishra U, Tyagi A, Parashar S. Laparoscopic heminephrectomy in horseshoe kidneys: A single center experience. Urol Ann 2017; 9:357-361. [PMID: 29118539 PMCID: PMC5656962 DOI: 10.4103/ua.ua_114_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction Laparoscopic approach in horseshoe kidney (HSK) is a challenge because of the aberrant vessels, the renal isthmus and the renal ectopia are all unique features of this anomaly encountered during the surgery. We report our single center experience with this technique in managing three patients with HSK. Methods A total of 15 cases (9 males and 6 females) were operated between June 2011 and December 2016 for various indications. Of these four patients were managed laparoscopically, two patients with HSK had non-functioning renal moiety underwent transperitoneal heminephrectomy. The third patient with a mass in right moiety with thin fibrous isthmus was successfully managed with laparoscopic heminephrectomy. Fourth patient with pelvi-ureteric junction obstruction with multiple renal calculi was managed with pyeloplasty and complete clearance of all calyceal the stones. Result Mean operating time was 140 ± 1.8 (100-180) min, and estimated blood loss was 131 ± 12.6 (30-320) ml. The mean hospital stay was 2.3 ± 1.4 (1-5) days. There were no major intra- and post-operative complications except minimal postoperative discomfort. Conclusion Laparoscopic nephrectomy is technically feasible, safe, and reliable for benign and malignant diseases in a HK with mainly three factors posing challenges during the surgery are the abnormal vasculature, division of the isthmus, and lower location of the kidney.
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Affiliation(s)
- Santosh Agrawal
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Jaisukh Kalathia
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Saurabh Sudhir Chipde
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Udit Mishra
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Anurag Tyagi
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Sanjay Parashar
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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Retroperitoneoscopic Partial Nephrectomy for a Horseshoe Kidney Tumor. Urol Case Rep 2017; 13:31-33. [PMID: 28435792 PMCID: PMC5394214 DOI: 10.1016/j.eucr.2017.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/16/2017] [Indexed: 12/04/2022] Open
Abstract
Horseshoe kidney is the most common renal fusion anomaly found in about 0.15% to 0.25% of the population. Renal cell carcinoma associated with a horseshoe kidney has been described in fewer than 200 cases. Its incidence and prognosis seems to be not different from those of the general population, but surgical management may be challenging due to unique anatomic features of horseshoe kidneys, such as highly variable vasculature. We report a case of a 69-year-old male with an incidental 48-mm solid mass in the left moiety of a horseshoe kidney, successfully treated by retroperitoneoscopic partial nephrectomy.
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Mano R, Hakimi AA, Sankin AI, Sternberg IA, Chevinsky MS, Russo P. Surgical Treatment of Tumors Involving Kidneys With Fusion Anomalies: A Contemporary Series. Urology 2016; 98:97-102. [PMID: 27498249 DOI: 10.1016/j.urology.2016.07.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To report a contemporary series of surgically treated patients with tumors involving kidneys with fusion anomalies. MATERIALS AND METHODS We retrospectively reviewed the medical records of all 10 patients treated at a single tertiary care institution for tumors involving kidneys with fusion anomalies between the years 2000 and 2015. One patient, diagnosed with lymphoma, did not undergo surgical treatment and was therefore excluded. Data regarding patient, tumor, and treatment characteristics were collected and described. RESULTS The study cohort included 7 male and 2 female patients, at a median age of 52 years. Seven patients underwent open partial nephrectomy. Nephroureterectomy was performed on 2 patients; 1 open and 1 laparoscopic. All patients had localized disease at diagnosis. Tumor histologies were renal cell carcinoma in 5 patients, renal oncocytoma in 1 patient, urothelial carcinoma in 2 patients, and a well-differentiated liposarcoma involving the kidney in 1 patient. Accessory blood vessels were identified in 8 of 9 patients. Median estimated blood loss was 300 mL (interquartile range: 150-1000). Four patients had postoperative complications, including 3 major (Clavien grade ≥ 3) and 3 minor (Clavien grade ≤ 2) complications. During a median follow-up of 19.2 months (interquartile range: 3-34.8), 1 patient with urothelial carcinoma developed a bladder recurrence. None of the patients developed new-onset chronic kidney disease during the early postoperative period. CONCLUSION Localized renal cortical tumors in kidneys with fusion anomalies may be treated with partial nephrectomy; however, complication rates are relatively high. Preoperative imaging of the blood vessels is necessary, as most patients have an accessory blood supply.
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Affiliation(s)
- Roy Mano
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander I Sankin
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Itay A Sternberg
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael S Chevinsky
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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En Bloc Retroperitoneoscopic Removal of Horseshoe Kidney for End-stage Renal Disease. Urology 2015; 86:814-6. [PMID: 26254173 DOI: 10.1016/j.urology.2015.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/03/2015] [Accepted: 07/14/2015] [Indexed: 11/23/2022]
Abstract
Horseshoe kidney (HSK) is the most common renal fusion anomaly. There have been reports of an association of HSKs with medical renal disease. We report a case of a child with nephrotic-range proteinuria and a HSK. As the patient was on peritoneal dialysis, the entire HSK was removed en bloc via a retroperitoneoscopic approach with early postoperative reinitiation of peritoneal dialysis.
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Benidir T, Coelho de Castilho TJ, Cherubini GRL, de Almeida Luz M. Laparoscopic partial nephrectomy for renal cell carcinoma in a horseshoe kidney. Can Urol Assoc J 2015; 8:E918-20. [PMID: 25553168 DOI: 10.5489/cuaj.2289] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Horseshoe kidney has an incidence rate ranging from 1 in 400 to 1 in 1000, with a 2:1 ratio in men. It also has a predilection for chromosomal aneuploidies. From a pathophysiology standpoint, this anomaly occurs during the second to sixth week of gestation when the inferior portion of the metanephric blastema fuses to form an isthmus, commonly in the lower renal pole (90%). As a result of this fusion, the kidney may not bypass the inferior mesenteric artery and is impeded in its ascent. With an aberrant anatomical orientation and location, complications arise including hydronephrosis, renal calculi and a twofold risk of Wilms tumour. Despite these findings, the association of renal cell carcinoma (RCC) within a horseshoe kidney is extremely rare and fewer than 200 cases have been described. Therapeutically speaking, partial nephrectomies are the gold standard of treatment for renal tumours smaller than 4 cm in diameter, with a growing indication to accomplish this procedure by laparoscopic or robotic means. We report a case of an asymptomatic 58-year-old male with an incidental computed tomography scan finding of a 4-cm solid mass in the right moiety of a horseshoe kidney. He was treated by laparoscopic partial nephrectomy. There have only been 2 other reported cases to our knowledge on a laparoscopic partial nephrectomy in a horseshoe kidney for RCC. We believe that, in experienced hands, the laparoscopic approach may be used successfully for this clinical situation.
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Affiliation(s)
| | | | | | - Murilo de Almeida Luz
- Hospital Erasto Gaertner - HEG, Curitiba (PR), Brasil; ; Hospital Israelita Albert Einstein - HIAE, São Paulo (SP), Brasil
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