Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

Ureter development and associated congenital anomalies

Malformations of the ureter are among the most common birth defects in humans. Although some of these anomalies are asymptomatic, others are clinically relevant, causing perinatal lethality or progressing to kidney failure in childhood. The genetic causes and developmental aetiology of ureteral anomalies are difficult to study in humans; however, embryological and genetic analyses in the mouse have provided insights into the complex developmental programmes that govern ureter formation from simple tissue primordia, and the pathological consequences that result from disruption of these programmes. Abnormalities in the formation of the nephric duct and ureteric bud lead to changes in the number of ureters (and kidneys), whereas the formation of ectopic ureteric buds, failure of the nephric duct to target the cloaca or failure of the distal ureter to mature underlie vesicoureteral reflux, ureter ectopia, ureterocoele and subsequent hydroureter. Alterations in ureter specification, early growth or cyto-differentiation programmes have now also been associated with various forms of perinatal hydroureter and hydronephrosis as a consequence of functional obstruction. The characterization of cellular processes and molecular drivers of ureterogenesis in the mouse may not only aid understanding of the aetiology of human ureteral anomalies, improve prognostication and benefit the development of therapeutic strategies, but may also prove important for efforts to generate a bioartificial organ.

Let's unravel the association between renal stones and renal variant vasculature in patients with duplex collecting system: A retrospective single institute study

Background

Our study aims to explore the association of duplex collecting systems with variable renal vasculature and renal calculi, given the paucity of published data on the subject.

Methodology

Between 2020 and 2023, retrospective research on patients with a duplex collecting system detected by CT scans was conducted at the radiology department of Shifa International Hospital. We assessed any gender bias and ascertained the frequency of this unilateral or bilateral duplex system abnormality. Furthermore, in patients who had received post-contrast imaging, the prevalence of renal calculi and varied renal vasculature was evaluated. In individuals with a duplex collecting system, the correlation between renal stones and renal variant vasculature was computed. SPSS version 25 was used to conduct the chi-square test.

Results

We retrospectively gathered data on patients with duplex collecting systems that showed only 65 patients. According to our research, bilateral participation is uncommon but the duplex collecting system is not side-specific. According to our statistics, this aberration has been more common in men as compared to women. Only 36 of the 65 patients in total had post-contrast imaging to check for variances in the vasculature. Of the 36 patients with renal vein variations, 11 had renal vein variations and 25 did not have any anatomical variations. Of the 25 individuals who did not have a renal vein variation, 19 did not have calculus, 2 had calculus involving the lower pole, and 4 had calculus involving the upper pole. 8 individuals with renal variations did not have renal calculus, 2 patients had lower pole calculus, and 1 patient had upper pole calculus. A negative uncertainty coefficient was seen between renal vein vasculature and calculus formation. 17 of the 36 patients had renal artery variations, whereas 19 patients had no anatomic variation of the renal artery. 12 of the 19 individuals without a renal artery variation had no calculus, 2 had calculus involving the lower pole, and 5 had calculus involving the upper pole. 2 individuals had calculus affecting the lower pole, 0 patients had calculus on the upper pole, and 15 patients with renal artery variations had no renal calculus. A positive uncertainty coefficient was seen between renal arterial vasculature and calculus formation.

Conclusion

Understanding renal vasculature patterns is vital for effective vascular interventions as well as kidney transplantations. Patients with a duplex collecting system are at increased risk of stasis, infections, and stone formation. For urologists and nephrologists, awareness of the association with variant renal vasculature is critical for managing complications related to this anomaly.

Multicystic dysplastic kidney in adults: A case report of unilateral presentation in an adult sudanese female

Multicystic dysplastic kidney is a congenital anomaly typically diagnosed in infancy, rare in adults, in our case of a 25-year-old Sudanese female presented with left flank pain. Imaging showed the left kidney replaced by cysts, consistent with MCDK, and ovarian cyst. She underwent a successful open simple nephrectomy; and histopathology confirmed MCDK. Our case highlights diagnostic and management challenges of MCDK in adults. Conservative management is increasing, especially for asymptomatic patients with normal contralateral kidney function. Healthcare barriers in Sudan, including limited awareness and political unrest, complicate timely diagnosis and treatment. Multidisciplinary care and improved healthcare access are essential.

Assessment of Kidney Function Discrepancies in Pediatric CAKUT Patients Using Bedside Schwartz Equation and Renal Scintigraphy

BACKGROUND AND OBJECTIVES

This research explores the correlation between estimated glomerular filtration rates (eGFR) obtained using the bedside Schwartz equation, and renal scintigraphy in children with congenital kidney and urinary tract abnormalities (CAKUT). The objective is to enhance understanding and management of renal health in this demographic by analyzing kidney size-function relationships.

METHODS

A retrospective observational analysis was performed on 94 pediatric CAKUT patients at the "Louis Turcanu" Emergency Hospital for Children, Timisoara. Kidney function data, extracted from medical records, were evaluated using the Schwartz equation, renal scintigraphy, and the gold standard iohexol clearance. Ethical approval was secured for the study, which employed descriptive and inferential statistical methods, including t-tests and correlation coefficients, to compare eGFR values.

RESULTS

Significant variances were found in eGFRs across different body surface area (BSA) percentiles. For instance, the eGFR for the right kidney in the 25th-50th BSA percentile (102.02 ± 41.52 mL/min/BSA) was notably higher than that of the left (35.60 ± 26.05 mL/min/BSA; p = 0.01). The overall sample reflected a higher eGFR in the right kidney (76.03 ± 40.91 mL/min/BSA) compared to the left (57.46 ± 35.91 mL/min/BSA; p = 0.02). Additionally, a strong positive Pearson correlation (r = 0.80, p = 0.02) was found between scintigraphy and ultrasound measures in the 50th-75th percentiles for left renal percentiles, demonstrating consistent patterns across different evaluations of kidney function.

CONCLUSIONS

This comparison indicates a complex relationship between eGFR values and kidney size, suggesting potential inaccuracies in standard bedside eGFR measurements for pediatric CAKUT patients. The findings underscore the necessity for accurate diagnostic tools specifically designed for pediatric applications and advocate for the integration of multiple diagnostic techniques to improve clinical management.

A triple kidney: Coexistence of normal left kidney and mal-rotated horseshoe anomaly: A rare case report

The occurrence of triple kidneys, involving a normal kidney and a malrotation horseshoe kidney, is an extremely infrequent condition. This case report demonstrates a triple, mal-rotated horseshoe kidneys coexist with an upper junction stone, alongside a normal left kidney showing normal Doppler vascularity, as observed in an ultrasound examination for 18-year-old male complaints of diffuse periumbilical pain and burning micturition. Laboratory investigation revealed normal creatinine level, and presence of urinary tract infection. Management option for this case are antibiotic therapy and surgical intervention for horseshoe kidney stone. Regular monitoring of kidney function, other radiographic imaging studies, and follow-up to assess the efficacy of the treatment, and detect any further complications are essential.

A Study of Clinical Profile of Congenital Anomalies of Kidney and Urinary Tract (CAKUT) in a Tertiary Care Center

Background  Congenital anomalies of the kidney and urinary tract (CAKUT) encompass a diverse array of disorders arising from developmental irregularities in the renal parenchymal development, disrupted embryonic migration of the kidneys, and the urinary collecting system. This study aimed to investigate the clinical presentations, patterns of obstructive and non-obstructive CAKUT, and associated extrarenal manifestations in affected children. Methods This observational study was conducted in the Department of Pediatrics, Acharya Vinoba Bhave Rural Hospital, Wardha. Ethical clearance was obtained, and the study included 105 diagnosed CAKUT patients aged from birth to 18 years. Data collection spanned from June 2022 to May 2024. Clinical features, antenatal findings, associated anomalies, estimated glomerular filtration rate (eGFR), and serum creatinine levels were recorded. Descriptive and inferential statistical analyses were performed using Stata software. Results Among the 105 participants, 81 (77.14%) were males, with a male-to-female ratio of 3.37:1. The mean age was 42.49 months. Forty-two individuals (40%) were asymptomatic, while the most common symptomatic presentation was the ventral opening of the urethra (24.76%). Extrarenal malformations were present in 35 subjects (33.33%), with undescended testis (25.71%) and congenital heart disease (CHD) (20%) being the most common. The antenatal diagnosis was made in 63.8% of cases. Obstructive uropathy was present in 42.86% of subjects, with a significant association between antenatal diagnosis and bilateral hydronephrosis. Medical management was provided to 41.9% of subjects, while 58.1% underwent surgical interventions. Conclusion The study highlights the clinical variability and diverse presentations of CAKUT in children, with a substantial proportion being asymptomatic. Early detection through antenatal screening and prompt intervention can potentially prevent or delay the progression to ESRD. The findings underscore the importance of comprehensive evaluation and targeted management strategies to address both renal and extrarenal manifestations of CAKUT.

A Pilot Comparative Study between Creatinine- and Cystatin-C-Based Equations to Estimate GFR and Kidney Ultrasound Percentiles in Children with Congenital Anomalies of the Kidney and Urinary Tract

Congenital anomalies affecting the kidneys present significant challenges in pediatric nephrology, needing precise methods for assessing renal function and guiding therapeutic intervention. Bedside Schwartz formula with the cystatin-C-based Full Age Spectrum formula and Chronic Kidney Disease in Children (CKiD) U 25 formula used in estimating glomerular filtration rate (eGFR) and also to assess if the eGFR in association with kidney length percentiles can be a monitoring parameter for the progression of chronic kidney disease in children with congenital anomalies of the kidney and urinary tract (CAKUT). A total of 64 pediatric patients (median age at diagnostic was 12 months with an interquartile range of 2 to 60) were diagnosed with congenital anomalies in the kidney and urinary tract between June 2018 and May 2023 at "Louis Turcanu" Emergency Hospital for Children in Timisoara, Romania. Baseline characteristics, CAKUT types, associated pathologies, CKD staging, and eGFR using creatinine and cystatin C were analyzed. The mean age at the moment of examination was 116.50 months; (65, 180). Chronic kidney disease staging revealed a predominance of patients in CKD stages G1 and A1. Analysis of eGFR methods revealed a small mean difference between eGFR estimated by creatinine and cystatin C, with a moderate-strong positive correlation observed between the eGFR and ultrasound parameters. Using cystatin-C-based formulas for eGFR, in conjunction with ultrasound measurements, may offer reliable insights into renal function in pediatric patients with congenital anomalies affecting the kidney and urinary tract. However, the economic aspect must be taken into consideration because cystatin C determination is approximately eight times more expensive than that of creatinine. An interdisciplinary approach is crucial for managing patients with CAKUT.

Ultrasound and magnetic resonance imaging features of fetal urogenital anomalies: A pictorial essay

This pictorial essay focuses on ultrasound (US) and magnetic resonance imaging (MRI) features of fetal urogenital anomalies. Fetal urogenital malformations account for 30%-50% of all anomalies discovered during pregnancy or at birth. They are usually detected by fetal ultrasound exams. However, when ultrasound data on their characteristics is insufficient, MRI is the best option for detecting other associated anomalies. The prognosis highly depends on their type and whether they are associated with other fetal abnormalities.

Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes

Congenital anomalies of the kidney and urinary tract (CAKUT) result from disruptions in normal kidney and urinary tract development during fetal life and collectively represent the most common cause of kidney failure in children worldwide. The antenatal determinants of CAKUT are diverse and include mutations in genes responsible for normal nephrogenesis, alterations in maternal and fetal environments, and obstruction within the normal developing urinary tract. The resultant clinical phenotypes are complex and depend on the timing of the insult, the penetrance of underlying gene mutations, and the severity and timing of obstruction related to the sequence of normal kidney development. Consequently, there is a broad spectrum of outcomes for children born with CAKUT. In this review, we explore the most common forms of CAKUT and those most likely to develop long-term complications of their associated kidney malformations. We discuss the relevant outcomes for the different forms of CAKUT and what is known about clinical characteristics across the CAKUT spectrum that are risk factors of long-term kidney injury and disease progression.

The genetics and pathogenesis of CAKUT

Congenital anomalies of the kidney and urinary tract (CAKUT) comprise a large variety of malformations that arise from defective kidney or urinary tract development and frequently lead to kidney failure. The clinical spectrum ranges from severe malformations, such as renal agenesis, to potentially milder manifestations, such as vesicoureteral reflux. Almost 50% of cases of chronic kidney disease that manifest within the first three decades of life are caused by CAKUT. Evidence suggests that a large number of CAKUT are genetic in origin. To date, mutations in ~54 genes have been identified as monogenic causes of CAKUT, contributing to 12-20% of the aetiology of the disease. Pathogenic copy number variants have also been shown to cause CAKUT and can be detected in 4-11% of patients. Furthermore, environmental and epigenetic factors can increase the risk of CAKUT. The discovery of novel CAKUT-causing genes is challenging owing to variable expressivity, incomplete penetrance and variable genotype-phenotype correlation. However, such a discovery could ultimately lead to improvements in the accurate molecular genetic diagnosis, assessment of prognosis and multidisciplinary clinical management of patients with CAKUT, potentially including personalized therapeutic approaches.

Case report: Rudimentary uterine horn with ovarian endometriosis manifested as pelvic ectopic kidney

Background

Unicornuate uterus is a congenital uterine malformation. Unicornuate uterus with rudimentary horn, ovarian endometriosis, and congenital renal agenesis are rare combinations that can be easily misdiagnosed due to the lack of typical clinical manifestations.

Case summary

A 19-year-old woman with pelvic pain was admitted to the hospital after a month. Physical examination was unremarkable. B-ultrasound and CT scan both indicated pelvic ectopic kidney. In addition, renal scintigraphy revealed normal perfusion and function of the right kidney, but the perfusion and function of the left kidney were not visible. A left pelvic ectopic kidney was diagnosed by preoperative images. A laparoscopic left pelvic ectopic nephrectomy was performed after adequate surgical preparation. However, the postoperative pathological diagnosis revealed a rudimentary uterine horn with ovarian endometriosis and congenital renal agenesis. Fortunately, she got recovered and was discharged from the hospital after 5 days following the operation. Moreover, she received regular follow-ups at the gynecology clinic. To date, no right adnexal or uterine abnormalities have been detected on ultrasound during the follow-up visits.

Conclusion

Rudimentary uterine horn with ovarian endometriosis and congenital renal agenesis are rare and are easily Misdiagnosed due to the lack of typical clinical manifestations. A gynecological examination is recommended for patients who may have this disease.

A Common Path: Magnetic Resonance Imaging of Müllerian and Wolffian Duct Anomalies

PURPOSE OF REVIEW

This review summarizes the pathway of Mullerian and Wolffian duct development, anomalies that result from disruptions to this pathway, and the characteristics on advanced imaging that identify them.

RECENT FINDINGS

In-office evaluation for reproductive anomalies is usually inadequate for the diagnosis of congenital reproductive anomalies. Magnetic resonance imaging (MRI) has usurped invasive diagnostic methods including laparoscopy, hysteroscopy, and vasography as the new gold standard. Because of its superior soft-tissue delineation and the availability of advanced functional sequences, MRI offers a sophisticated method of distinguishing reproductive anomalies from one another, characterizing the degree of defect severity, and evaluating for concomitant urogenital anomalies non-invasively and without radiation exposure to the patient. Congenital anomalies of the Mullerian and Wolffian duct can be incredibly nuanced, requiring prompt and accurate diagnosis for management of infertility. Definitive diagnosis should be made early with MRI.

The importance of CT Urography in early diagnosis of anatomical variations in urogenital tract: case presentation

Anatomic variations in the urogenital tract have generally been diagnosed through intravenous urography as a modality of choice. In recent years, computerized tomography (CT) urogram has replaced the traditional intravenous imaging of the genitourinary tract. Hematuria, tumoral mass, obstructive uropathy, and congenital collecting system abnormalities are indications for CT imaging. In this report, we present a young woman with intermittent right flank pain and recent urinary tract infection. Her history was also positive for spontaneous abortion. She was referred to the Radiology Clinic for a CT urography. Our aim, in this case report, is to highlight the role of CT urography in the early diagnosis of anatomical variations of the urogenital system and appropriate prevention of clinical progression.

Should we screen for Müllerian anomalies following diagnosis of a congenital renal anomaly?

INTRODUCTION

Despite the well-established embryological relationship in the development of renal and Müllerian structures, no clear guidelines exist regarding screening for Müllerian anomalies (MA) in the setting of a renal anomaly (RA). Delayed diagnosis of MA can have significant reproductive consequences.

OBJECTIVE

To investigate the prevalence of coexisting MA in patients with congenital RA.

STUDY DESIGN

This is a retrospective cohort study of females age 12-35 years with a diagnosis of RA, identified by diagnosis codes, who were followed for care between 2013 and 2020. Data were collected on demographics, medical history, clinical presentation, and imaging studies. Descriptive statistics were used to summarize the data. This study was IRB approved.

RESULTS

A total of 465 patients were included in this study, of whom 326 patients (70.3%) had a pelvic evaluation during the study period. Of these 326 patients, 125 (38.3%) were found to have coexistent MA. About one-third of patients who underwent pelvic evaluation due to pain were found to have MA. For 69.6% (87/125) of patients with MA, the RA was diagnosed prior to the MA. The average age at time of RA diagnosis was 6.4 ± 8.8 years and the average age of MA diagnosis was 16.4 ± 6.9 years. Forty-eight (38.4%) patients had obstructive anomalies. Of the Müllerian obstructions, 93.8% were treated with urgent surgery and the remainder started on hormonal suppression. The prevalence of MA was dependent on the RA diagnosis (Figure). Of patients with a solitary kidney, 67.1% were diagnosed with MA. For other parenchymal RA, the prevalence of MA was 20-23%. In patients with solitary kidney, uterus didelphys was the most common MA (52.1%). Thirty percent of patients with a solitary kidney were diagnosed with an obstructive MA.

CONCLUSIONS

In this study, 38% of patients with RA who underwent a pelvic evaluation were found to also have MA. Our study shows the strongest association between MA and solitary kidney, but also emphasizes a significant risk with other RA. Almost 40% of patients with diagnosed MA were found to have an obstruction that required urgent treatment. Delays in diagnosis and treatment of Müllerian obstructions can be detrimental for future reproductive health, due to risk of chronic pain, infertility, infection, and endometriosis. Given the high prevalence of MA in patients with RA, especially those with congenital solitary kidney, routine screening with pelvic ultrasound should be performed around the age of expected menarche.

Ectopic lesions in the abdomen and pelvis: a multimodality pictorial review

Various ectopic lesions occur in the abdomen and pelvis and affect multiple organs including liver, gallbladder, pancreas, spleen, and organs of the genitourinary system. Ectopic organs may be present outside their normal positions, or ectopic tissues may develop while the original organ exists in its normal position. Both benign and malignant lesions can occur in ectopic organs and tissues. Owing to their unusual location, they can often be misdiagnosed as other lesions or even malignant lesions, such as metastasis or seeding. This multimodality pictorial review provides various cases of ectopic lesions in the abdomen and pelvis, which will help narrow the differential diagnosis and guide clinical decision-making.

[Incidental and leave me alone findings of abdominal organs-part 2 : Spleen, kidneys and adrenal glands and efferent urinary tracts]

For masses of the spleen, which are mostly benign, accessory spleens, cysts and hemangiomas should be radiologically described; however, if confirmed further follow-up control is unnecessary. In the case of disseminated small masses, chronic inflammation and granulomatous diseases, such as tuberculosis and sarcoidosis should be considered in the differential diagnostics. Solid masses in the kidneys should always be further clarified, with the exception of a fat-rich angiomyolipoma. For cystic masses of the kidneys, the modified Bosniak classification for computed tomography or magnetic resonance imaging should be used. Masses of the adrenal glands greater than 10mm in size should be clarified further as well as those where fat is not detected, independent of the size and evidence of malignancy.

Conventional uroradiology with excretory urography: a forgotten art?

Excretory urography (EU) had been the most frequently performed imaging modality for uroradiology in the past. With the advances in ultrasonography, and development of cross-sectional urography with CT and MRI, EU is now seldom performed. Consequently, there has been a decline of expertise in this technique. However, EU has multiple advantages such as dynamic nature, easy availability, low cost and radiation burden. These render it potentially very valuable in specific indications like congenital anomalies, urothelial lesions and urinary leaks. This review intends to emphasize the current day relevance of excretory urography, outline the key points of the technique, and describe the pearls and pitfalls of interpretation.

Imaging of congenital genitourinary anomalies

Congenital genitourinary anomalies are among the most frequent types of birth defects in neonates. Some anomalies can be a significant cause of morbidity in infancy, while others remain asymptomatic even until adulthood and can be at times the only manifestation of a complex systemic disease. The spectrum of these anomalies results from the developmental insults that can occur at various embryologic stages, and an understanding of the formation of the genitourinary system is helpful in the evaluation and treatment of a child with a congenital genitourinary anomaly. Imaging plays an essential role in the diagnosis of congenital genitourinary anomalies and treatment planning. In this article, we highlight the embryologic and characteristic imaging features of various congenital genitourinary anomalies, demonstrate the utility of different imaging modalities in management, and review specific imaging modalities and protocols for image optimization.

Unilateral hypoplastic kidney in adults: An experience of a tertiary-level urology center

BACKGROUND

Unilateral small-sized kidney is a radiological term referring to both the congenital and acquired causes of reduced kidney volume. However, the hypoplastic kidney may have peculiar clinical and radiological characterizations.

AIM

To evaluate the clinical presentations, complications, and management approaches of the radiologically diagnosed unilateral hypoplastic kidney.

METHODS

A retrospective review of the records of patients with a radiological diagnosis of unilateral hypoplastic kidney between July 2015 and June 2020 was done at Assiut Urology and Nephrology Hospital, Assiut University, Egypt.

RESULTS

A total of 33 cases were diagnosed to have unilateral hypoplastic kidney with a mean (range) age of 39.5 ± 11.2 (19-73) years. The main clinical presentation was loin pain (51.5%), stone passer (9.1%), anuria (12.1%), accidental discovery (15.2%), or manifestations of urinary tract infections (12.1%). Computed tomography was the most useful tool for radiological diagnosis. However, radioisotope scanning could be requested for verification of surgical interventions and nephrectomy decisions. Urolithiasis occurred in 23 (69.7%) cases and pyuria was detected in 22 (66.7%) cases where the infection was documented by culture and sensitivity test in 19 cases. While the non-complicated cases were managed by assurance only (12.1%), nephrectomy (15.2%) was performed for persistent complications. However, symptomatic (27.3%) and endoscopic (45.6%) approaches were used for the management of correctable complications.

CONCLUSION

Unilateral hypoplastic kidney in adults has various complications that range from urinary tract infections to death from septicemia. Diagnosis is mainly radiological and management is usually conservative or minimally invasive.

Imaging Review of Obstetric Sequelae of Maternal Diabetes Mellitus

Diabetes mellitus, whether preexisting or gestational, poses significant risk to both the mother and the developing fetus. A myriad of potential fetal complications in the setting of diabetic pregnancies include, among others, congenital anomalies, delayed fetal lung maturity, macrosomia, and increased perinatal morbidity and mortality. Congenital anomalies most commonly involve the nervous, cardiovascular, genitourinary, and musculoskeletal systems. Delayed fetal lung maturity, probably secondary to hyperglycemia suppressing surfactant secretion, is a major determinant of perinatal morbidity and mortality. Besides the potential complications encountered during cesarean delivery in macrosomic fetuses, vaginal delivery is also associated with increased risks of shoulder dystocia, clavicular and humeral fractures, and brachial plexus palsy. Maternal complications are related to the increased risk of hypertensive diseases of pregnancy and associated preeclampsia and hemolysis, elevated liver function, and low platelets (HELLP) syndrome, as well as complications encountered at the time of delivery secondary to fetal macrosomia and cesarean delivery. Additional conditions encountered in the setting of maternal diabetes include polyhydramnios, placental thickening, and two-vessel umbilical cord, each of which is associated with adverse fetal and maternal outcomes including fetal growth restriction, preterm labor, placental abruption, and premature rupture of membranes. Imaging plays a vital role in the evaluation of the mother and the fetus and can provide invaluable information that can be used by maternal fetal medicine to manage this patient population effectively. The authors review the pathophysiologic alterations induced by diabetes in pregnancy, discuss the imaging spectrum of diabetic embryopathy, and provide a detailed review of potential associated maternal complications. Online supplemental material is available for this article. ^©RSNA, 2021.

Minimal invasive approach for lower pole uretero-pelvic junction obstruction (UPJO) in duplication anomaly: A multi-institutional study

PURPOSE

We present a multi-institution experience of laparoscopic and robotic-assisted reconstruction approach of lower-pole UPJO (ureteropelvic junction obstruction) in duplicated collecting systems.

METHODS

Retrospective review of patients who underwent laparoscopic or robotic pyeloplasty for lower pole UPJO between 2011 and 2020. Patient demographics, perioperative surgical data, complications and outcomes are described. Surgical approach was adjusted to the anatomic variant. Success was defined as improved hydronephrosis, indicated by improved Society of Fetal Urology classification at 9 months follow up.

RESULTS

Forty-one patients underwent MIS reconstruction surgery of lower pole UPJO (38- laparoscopy, 3- robot assisted). Median age at surgery was 13 months (IQR, 5-32). Mean operative time was 80 min (IQR, 70-110). There were no intraoperative complications, no conversions and estimated blood loss was negligible. Lower pole dismembered pyeloplasty was performed in 19 (46%) patients, uretero-pyelostomy (lower pole pelvis to upper pole ureter) in 15 (36.5%), concomitant obstruction of the upper pole moiety was encountered in 4 (10%) patients; lower pole dismembered pyeloplasty and upper pole ureter to lower pole pelvis (end-to-side uretero-pyelostomy) was performed and concomitant ipsilateral upper pole partial nephrectomy was carried out in 3 (7%) patients. Overall, 3 patients had grade 1 or 2 Clavien-Dindo postoperative complications and one patient developed a grade 3 complication. Surgical success was achieved in 38/41 (93%), 3 patients required an additional procedure.

CONCLUSIONS

UPJO of lower pole of duplication anomaly is highly variable anatomically; therefore, an individualized surgical approach is mandatory. The minimal invasive approach is feasible and safe with good outcomes.

Unveiling the confusion in renal fusion anomalies: role of imaging

Renal fusion anomalies are common congenital anomalies of the urogenital tract and have their genesis in the early embryonic period. They are classified into partial fusion anomalies (e.g., crossed fused ectopia, and horseshoe kidney) and complete fusion anomalies (e.g., fused pelvic kidney). Horseshoe kidney is the most common renal fusion anomaly and is characterized by the presence of two distinct functioning kidneys on either side of the vertebral column, with fusion occurring at the inferior poles in majority of the cases. Crossed fused ectopia is characterized by the presence of an ectopic kidney that crosses the midline and fuses with the orthotopic contralateral kidney, whereas fused pelvic (pancake) kidney is a complete fusion anomaly characterized by extensive medial fusion of both kidneys in the pelvis. Fusion anomalies are often associated with abnormalities of renal rotation, migration, and vascular supply, which predispose the kidneys to a number of complications and create difficulty during retroperitoneal surgeries and interventions. They are also associated with other congenital abnormalities of the urogenital tract, gastrointestinal tract, cardiovascular system, and skeletal system. Hence, a thorough understanding of the etiopathogenesis and radiological features of fusion anomalies is important for directing patient management. This review summarizes the embryological basis, clinical presentation and imaging approach to renal fusion anomalies, followed by detailed anatomical and radiological description of the morphological types, and the complications associated with these anomalies.

Urinary Incontinence in Adulthood in a Course of Ectopic Ureter-Description of Two Clinical Cases with Review of Literature

Urinary tract pathologies are the most common congenital abnormalities. Duplex colleting system occurs at different stages of completion and is usually asymptomatic. Ureteral ectopia is an associated anomaly which may manifest as continuous incontinence. The aim of this article is to present two patients with duplex kidney and ureteral ectopia. Both patients presented symptoms of continuous urinary incontinence and became symptomatic in the adult life.

CTU findings of duplex kidney in kidney: A rare duplicated renal malformation

Duplex kidney is a common congenital malformation appeared as duplication of pelvis and ureter. However, renal duplication within sinus renalis is an extremely rare variation of the renal collecting system. In this study, we report a case of an asymptomatic kidney disease in a 33-year-old man, who demonstrates abnormal echo of renal sinus anomaly discovered incidentally in ultrasound examination. Computed tomography urography (CTU) exhibited the other small duplex kidney located in renal sinus. In the excretory phase images, the contrast medium within its small renal pelvis could be seen to flow into the right major renal calices. This case exhibited a very rare anatomical variation of duplicated renal malformation.

Supernumerary Kidney Associated With Horseshoe Malformation and Ureteric Stricture With Hydroureteronephrosis - A Rare Case

Supernumerary kidney is an accessory kidney with its own vasculature, collecting-system and encapsulated parenchyma with about 100 cases reported in the literature. However, there is no report of supernumerary kidney associated with horseshoe malformation with ureteric stricture. We report a rare case of 20 months old female admitted with left-sided abdomen lump and mild abdominal pain. During surgery, supernumerary kidney with horseshoe component with grossly-dilated left-sided pelvicalyceal system and proximal 1-cm of left-ureter, distal to which whole of left-ureter was noncanalized, was seen. Right-ureter was normal. Distal dilated part of left-ureter was anastomosed to bladder-dome after excision of strictured segment of left-ureter with placement of nephrostomy.

A Unique Case of Incomplete Bifid Ureter and Associated Arterial Variations

Introduction. Urogenital and vascular anomalies, including a left duplex kidney and a left aberrant renal artery that gave rise to the left ovarian artery, were observed in a 77-year-old female cadaver during a routine dissection. Description. A left aberrant renal artery, which gave rise to the left ovarian artery, was observed originating from the aorta 4 cm below the left renal artery. Two independent contributions to a bifid ureter were found originating from the hilum of the left kidney. These two contributions descended 12.4 cm and 10.6 cm, respectively, posterior to the left aberrant renal artery and lateral to the left ovarian artery before uniting anterior to the psoas major muscle to descend 12.7 cm to the bladder. Significance. While the duplex kidney is a relatively common congenital anomaly that can be asymptomatic, it can also potentially be associated with compression of renal vasculature or the ureter. Ureteral compression can then result in several pathologies including reflux, urinary tract infection (UTI), ureteropelvic junction obstruction, or hydronephrosis. Compression of renal and ovarian vasculature can result in altered blood flow to the kidney and ovary, potentially causing fibrosis, atrophy, or organ failure. Current imaging techniques alone are insufficient for correct diagnostics of such complications, and they must be supplemented with a thorough understanding of the respective anatomical variations.

Robot-assisted laparoscopic pyeloplasty: A retrospective case series review

Introduction

Anderson-Hynes pyeloplasty has been gold standard in the management of pelviureteric junction obstruction (PUJO). It has evolved from open to laparoscopic and now robotic surgery. Open surgery has its drawback of long incision and scar mark, significant post-operative pain and long hospital stay. The main limitation of laparoscopic surgery had been the difficulty in endosuturing. Robotic surgery has incorporated the minimal access method of laparoscopy and endowrist movement of open surgery to overcome the challenge of intracorporeal suturing. Here, we present our initial experience of robotic pyeloplasty.

Patients and Methods

A total of 30 patients underwent robot-assisted laparoscopic pyeloplasty (RALP) over 19 months. Diagnosis of PUJO was made by computed tomography urography, diuretic renogram and retrograde pyelogram in selected patients. All patients underwent RALP by colon reflecting approach. Post-operative evaluation was done by DTPA scan at 3- and 6-month follow-up. Data were analysed after a mean follow-up of 11 months.

Results

The mean operative time was 148 min and the mean hospital stay was 3.5 days. While 93% of the patients showed objective improvement in their drainage pattern on DTPA renogram, 90% of the patients were symptom-free at the end of 6 months.

Conclusions

Robotic pyeloplasty is a safe and easily conquerable technique with comparable outcomes in the hands of surgeons who are beginners in this technique.

Right supernumerary kidney with urothelial carcinoma: A case report

RATIONALE

A supernumerary kidney is an extremely rare renal anomaly. Currently, <100 cases are reported in the literature. There are only 2 right unilateral supernumerary kidneys reported in the literature thus far, but no confirmed cases of urothelial carcinoma in supernumerary kidneys. We report a case of a right supernumerary with urothelial carcinoma, which is, to the best of our knowledge, reported for the first time.

PATIENT CONCERNS

A 73-year-old female patient presented with intermittent, painless, whole course and gross hematuria for about 3 months. Her physical and laboratory examinations did not reveal any significant findings except positive occult blood in routine urine examination. Contrast-enhanced spiral computed tomography revealed a dysplastic supernumerary kidney under the normal right kidney.

DIAGNOSES

The ureteroscopy showed that the ureter was Y-shaped in the middle part. The medial ureter led to a normal kidney. The lateral ureter was just 2 cm and led to a small cavity in which there was a mass whose biopsy showed urothelial carcinoma. The patient was subsequently diagnosed with a right supernumerary kidney with urothelial carcinoma.

INTERVENTION

Nephroureterectomy, including the right normal and supernumerary kidneys, and partial cystectomy by laparoscopy were performed after the ureteroscopy. The patient then received 6 cycles of gemcitabine and cisplatin regimen chemotherapy and regular intravesical epirubicin chemotherapy.

OUTCOMES

No recurrence or metastasis was found on follow-up computed tomography performed 13 months postoperatively.

LESSONS

A supernumerary kidney is an extremely rare renal anomaly. Malignancy can occur in supernumerary kidneys.

Duplication of ureter in a 7-year-old: a case report

Duplication of ureter is one of the most common anomalies of the urinary tract. Early detection has dramatically increased due to advance in technology of imaging to detect the anomalies during antenatal period; however, numbers of undiagnosed adult still exist. It may remain asymptomatic, but may cause repeated urinary tract infections or calculi. This case report presents a case of a 7-year-old female who had duplex collecting systems. This patient has repeating symptoms throughout the years, referred to several medical specialties. Then ultrasonography and computed tomography showed that she had complete duplex collecting system on her left kidney. She was then undergone left partial nephrectomy surgery and removal of dilated left ureter. Congenital anomaly of the urogenital system should be considered in patients with chronic infection. Multimodal imaging technique such as ultrasonography, computed tomography, or magnetic resonance imaging should be done to confirm the diagnosis especially before surgical management.

Utilization of Diagnostic Testing for Renal Anomalies and Congenital Heart Disease in Patients with Microtia

Objective

Congenital ear anomalies are associated with congenital cardiac and renal defects. Renal ultrasounds, electrocardiogram, and echocardiogram can be utilized for diagnosis of these concurrent defects. No standard of care exists for the workup of patients with microtia. The goals of this study were to describe the utilization of diagnostic testing for cardiac and renal anomalies and to identify their prevalence in patients with microtia.

Study Design

Case series with chart review.

Setting

Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center.

Subjects and Methods

This study is an Institutional Review Board–approved retrospective review of consecutive patients born between 2002 and 2016 who were diagnosed with microtia and seen in the otolaryngology clinic at a tertiary care children’s hospital. Demographics, sidedness and grade of microtia, comorbid diagnoses, and details of renal and cardiovascular evaluations were recorded. Factors associated with retroperitoneal ultrasound and cardiac testing were assessed with logistic regression.

Results

Microtia was present in 102 patients, and 98 patients were included as they received follow-up. Microtia was associated with craniofacial syndrome in 34.7% of patients. Renal ultrasound was performed in 64.3% of patients, and 12.9% of patients with ultrasounds had renal aplasia. Cardiac workup (electrocardiogram or echocardiogram) was completed in 60.2% of patients, and of this subset, 54.2% had a congenital heart defect.

Conclusion

Diagnostic testing revealed renal anomalies and cardiac defects in patients with isolated microtia at a higher rate than in the general population. This suggests the need for further evaluation of the role of routine screening in patients with microtia.

Pancake kidney, a rare and often misdiagnosed malformation: a case report and radiological differential diagnosis

Renal ectopia and fusion anomalies are Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT) that are usually incidentally detected and asymptomatic. Patients affected present a higher risk of complications like recurrent urinary tract infections or obstruction. Pancake kidney (PK) is one of the rarest types of renal anomaly with complete fusion of the superior, mild and inferior poles of both kidneys in the pelvic cavity. Each kidney has its own excretory system with two ureters that do not cross the midline. In the asymptomatic cases, a conservative approach should be performed. Surgical management may be needed when urological problems occur. PK is often associated with congenital anomalies of other organs. Ultrasound is the first line radiological examination for the diagnosis and the follow-up of kidney malformations. The main sonographic findings suggesting PK diagnosis are a large and lobulated renal mass consisting of two fused lateral lobes without an intervening septum located in the pelvic cavity. Each lobe usually has a separate pelvicalyceal system, the renal pelvis is anteriorly placed and the ureters are usually short and enter the bladder normally without crosses the midline. Ultrasonography gives useful information on the morphology and volume of the organ, and on its vascularization through the use of the Color- and Power-Doppler. Computer Tomography and Magnetic Resonance Urography are second level techniques used to confirm the diagnosis and to evaluate the presence of other abnormalities. The knowledge of the imaging findings and the anatomy of congenital renal malformations is important to avoid diagnostic pitfalls and misinterpretations. We report the case of a 14-years old female with PK who was misdiagnosed with a horseshoe kidney (HSK) during an abdominal ultrasound.

Bilateral duplex collecting system with bilateral vesicoureteral reflux: a case report

Background

A bilateral duplex collecting system is an unusual renal tract abnormality. Vesicoureteral reflux may be associated. We describe a rare case of bilateral duplex collecting system with bilateral vesicoureteral reflux in which the refluxing ureter on the left side drains the upper pole moiety contrary to what is often found.

Case presentation

A 24-year-old married Arab woman presented with ascending left-sided flank pain during micturition. She complained of recurrent urinary tract infections. A physical examination and laboratory tests were normal. Voiding cystourethrography and computed tomography scan detected bilateral duplex collecting system, grade IV vesicoureteral reflux on the left side, and grade I vesicoureteral reflux on the right. She underwent left heminephrectomy and dextranomer/hyaluronic acid injections on the right side. After a year of follow-up, a clinical examination and imaging findings were unremarkable.

Conclusions

A bilateral duplex collecting system with refluxing upper pole moiety ureter is a very rare entity. The diagnosis should be suspected when exploring any flank pain with recurrent urinary tract infections to avoid subsequent renal impairment. Furthermore, this case shows how some common symptoms may lead to finding an unexpected urinary tract abnormality.

Prevalence, types, and malformations in congenital anomalies of the kidney and urinary tract in newborns: a retrospective hospital-based study

Background

Congenital anomalies of the kidney and urinary tract (CAKUTs) are some of the most common birth defects affecting newborns. CAKUTs often have poor birth outcomes owing to the limited experience of physicians in developing countries regarding antenatal and postnatal diagnosis. We aimed to estimate the epidemiology of CAKUTs using data from a hospital-based registry in Zhejiang Province, China.

Methods

We included a total of 2790 newborns with CAKUTs, identified among 1,748,038 births during 2010–2016. The prevalence and type of CAKUTs, maternal and neonatal characteristics, and associated malformations were analyzed.

Results

The average prevalence of CAKUTs born to mothers overall and mothers aged ≥35 years were both around 1.60 per 1000 births (95% confidence interval (CI), 1.54–1.66; 95% CI, 1.44–1.83, respectively) during the study period. The prevalence of CAKUTs changed over time among all women and women of advanced maternal age, although no significant trends were observed. CAKUTs were more likely to occur in male than female newborns (odds ratio (OR) 1.28, 95% CI 1.18–1.38), in multiple births than singletons (OR 1.53, 95% CI 1.21–1.92) and in urban areas than rural areas (OR 1.27, 95% CI 1.18–1.37). The overall prenatal detection rate of CAKUTs was 73.87%. The average gestational age at antenatal diagnosis was 26.57 ± 8.70 weeks. A total 22.69% CAKUTs had associated malformations. Congenital heart defects were the most common anomalies, accounting for 8.89% of the whole population. The main proportion in subgroups was hydronephrosis, representing 31.79% of registered CAKUTs.

Conclusions

There was a nearly twofold increase in the prevalence of CAKUTs from 2010 to 2016 in Zhejiang Province. CAKUTs are strongly associated with male sex, multiple births, urban areas, and other nonurinary congenital malformations.

Primary Extrarenal Type 2 Papillary Renal Cell Carcinoma: A Case Report

Type 2 papillary renal cell carcinoma (PRCC) is a malignant tumor originated from renal tubular epithelial cells. Here we present a rare case of extrarenal type 2 PRCC which is located at the right lateral side of the retroperitoneal inferior vena cava. No suspicious lesions were detected in the bilateral kidneys. The diagnosis was confirmed by histopathological examination after complete excision of the tumor. No recurrence was observed in 5 months of follow-up after surgery.

Bifid ureter with blind-ending branch: A rare anatomic variant detected during antegrade ureteric stent insertion

Anatomic variants of the urinary tract are relatively common; however, a bifid ureter with a blind-ending branch is a rare congenital anomaly. This variant often goes unnoticed because patients are either asymptomatic or complain of vague abdominal symptoms. Diagnosis is often incidental, and may be missed on conventional imaging. Although bifid ureters usually do not require any specific investigations or treatment; it is important to have an appreciation for these anomalies particularly if radiological intervention or surgical procedures are planned. We describe a case of a blind-ending bifid ureter in a patient with bilateral hydronephrosis secondary to a large cervical malignancy. The presence of the bifid ureter was only appreciated during a technically challenging antegrade ureteric stent insertion several weeks after diagnosis. We review the clinical significance, embryology, and radiology findings of this anomaly, as well as the implications during radiological interventional procedures.

Use of MR Urography in Pediatric Patients

PURPOSE OF REVIEW

In this article, we describe the basics of how magnetic resonance urography (MRU) is performed in the pediatric population as well as the common indications and relative performance compared to standard imaging modalities.

RECENT FINDINGS

Although MRU is still largely performed in major academic or specialty imaging centers, more and more applications in the pediatric setting have been described in the literature. MRU is a comprehensive imaging modality for evaluating multiple pediatric urologic conditions combining excellent anatomic detail with functional information previously only available via renal scintigraphy. While generally still reserved for problem solving, MRU should be considered for some conditions as an early imaging technique.

Young man with acute pain in the hypogastrium: What is the diagnostic?

Congenital renal anomalies can stay asymptomatic even until adult age and be revealed by occurrence of complications. Clinicians should keep in mind this eventuality, especially in the countries where screening for congenital abnormalities is not adopted. Ultrasound in front of abdominal pain is useful and can sometimes rectify the diagnosis.

Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, Middeldorp S, Nelen W, Peramo B, Quenby S, Vermeulen N, Goddijn M. ESHRE guideline: recurrent pregnancy loss

STUDY QUESTION

What is the recommended management of women with recurrent pregnancy loss (RPL) based on the best available evidence in the literature?

SUMMARY ANSWER

The guideline development group formulated 77 recommendations answering 18 key questions on investigations and treatments for RPL, and on how care should be organized.

WHAT IS KNOWN ALREADY

A previous guideline for the investigation and medical treatment of recurrent miscarriage was published in 2006 and is in need of an update.

STUDY DESIGN, SIZE, DURATION

The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 31 March 2017 and written in English were included. Cumulative live birth rate, live birth rate and pregnancy loss rate (or miscarriage rate) were considered the critical outcomes.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee.

MAIN RESULTS AND THE ROLE OF CHANCE

The guideline provides 38 recommendations on risk factors, prevention and investigations in couples with RPL, and 39 recommendations on treatments. These include 60 evidence-based recommendations – of which 31 were formulated as strong recommendations and 29 as conditional – and 17 good practice points. The evidence supporting investigations and treatment of couples with RPL is limited and of moderate quality. Of the evidence-based recommendations, only 10 (16.3%) were supported by moderate quality evidence. The remaining recommendations were supported by low (35 recommendations: 57.4%), or very low quality evidence (16 recommendations: 26.2%). There were no recommendations based on high quality evidence. Owing to the lack of evidence-based investigations and treatments in RPL care, the guideline also clearly mentions investigations and treatments that should not be used for couples with RPL.

LIMITATIONS, REASONS FOR CAUTION

Several investigations and treatments are offered to couples with RPL, but most of them are not well studied. For most of these investigations and treatments, a recommendation against the intervention or treatment was formulated based on insufficient evidence. Future studies may require these recommendations to be revised.

WIDER IMPLICATIONS OF THE FINDINGS

The guideline provides clinicians with clear advice on best practice in RPL, based on the best evidence available. In addition, a list of research recommendations is provided to stimulate further studies in RPL. One of the most important consequences of the limited evidence is the absence of evidence for a definition of RPL.

STUDY FUNDING/COMPETING INTEREST(S)

The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payment. J.E. reports position funding from CARE Fertility. S.L. reports position funding from SpermComet Ltd. S.M. reports research grants, consulting and speaker’s fees from GSK, BMS/Pfizer, Sanquin, Aspen, Bayer and Daiichi Sankyo. S.Q. reports speaker’s fees from Ferring. The other authors report no conflicts of interest.

ESHRE Pages are not externally peer reviewed. This article has been approved by the Executive Committee of ESHRE.

[One-phase split-bolus CT Urography - a novel approach to reduce radiation dose in diagnostics of congenital anomalies of kidneys and urinary tract in children]

BACKGROUND

Low-dose CT Urography (LD-CTU) has become a standard procedure in urinary tract abnormalities in children, especially when MR Urography is not available. Standard one-phase CTU is performed in excretory phase. There is also a split-bolus technique, which combines two or even three phases during one scan and provides more clinical information without higher radiation exposure. It can be implemented for congenital anomalies of kidneys and urinary tract (CAKUT) in children, however, this application is not deeply discussed in scientific literature. Aim of this publication is to present the protocol and determine the role of LD-CTU in diagnostic imaging of CAKUT in children.

MATERIAL AND METHODS

Close to 300 CTUs in children were performed as a standard of care during the last 6 years in our Department. Diagnostic accuracy in suspected CAKUT was analyzed, depending on applied protocol - standard excretory CTU, multiphase CTU and two different one-phase split-bolus CTU protocols.

RESULTS

Visualization of the urinary tract was adequate in all study protocols. However, more clinically significant information was received in vascular-excretory protocol, including vascular and renal anatomy. Radiation exposure was similar or even lower than in other study protocols.

CONCLUSIONS

One-phase split-bolus CTU protocol is a novel approach in low-dose diagnostic imaging of CAKUT in children. Combination of vascular and excretory phases has been shown as very effective technique, especially in comprehensive anatomical assessment of the abnormality and qualification to surgical intervention.

Duplex collecting system in a pelvic kidney - an unusual combination

Pelvic kidney is a relatively common renal malformation as well as duplex kidney; however, the unilateral coexistence of these abnormalities is not frequently found. We present a case of a young woman with a history of hypertension in whom a pelvic and dysmorphic left kidney was discovered during ultrasound examination performed for the study of the renal arteries. Magnetic resonance imaging and computed tomography imaging revealed a duplex pelvic kidney. This combination is very rare; we have not found a similar case reported in the literature.

Prevalence of Renal and Cervical Vertebral Anomalies in Patients with Isolated Microtia and/or Aural Atresia

Objective

The objective of this study was to determine whether patients with isolated microtia or aural atresia have an increased prevalence of renal or cervical vertebral anomalies.

Design

The study design was a retrospective medical record review.

Setting

The setting was the following four distinct institutions: an urban tertiary care children's hospital, two urban academic medical centers, and a staff-model health maintenance organization.

Participants

Patients diagnosed with microtia, aural atresia, or oculoauriculovertebral spectrum were identified. Patients with facial asymmetry, craniofacial microsomia, and other craniofacial abnormalities or syndromes were excluded.

Main Outcome Measures

Main outcome measures were the number of patients with isolated microtia or aural atresia who underwent a renal ultrasound or cervical spine X-ray, the results of those studies, and further evaluation or treatment for any abnormalities found.

Statistical Analysis

A binomial analysis using a one-sided 95% confidence level was performed.

Results

A total of 514 patients with isolated microtia and/or aural atresia were identified. Of these patients, 145 (28%) had undergone a renal ultrasound and 81 (16%) had undergone cervical spine X-rays. A total of 3 patients (2%) had minimal renal pelviectasis, all of which had resolved on repeat ultrasound and required no treatment. There were no structural renal abnormalities identified, and there were no cervical spine abnormalities identified.

Conclusions

The data suggest that there is no increased prevalence of structural renal or cervical vertebral anomalies in patients with isolated microtia and/or aural atresia. Therefore, these patients do not require routine screening renal ultrasound or cervical spine X-rays.

The safety and efficacy of MPR-CTU combined with precise intraoperative ultrasonography guided flexible ureteroscope in the treatment of renal cystic disease

The safety and efficacy of multi-planar reconstruction (MPR) image post-processing technique-computed tomography (CT) urography (CTU) combined with precise intraoperative ultrasonography guided flexible ureteroscope in renal cyst incision and drainage in the treatment of cystic diseases of kidney were evaluated. A total of 68 patients were randomly divided into control and observation group (n=34). All the patients were treated with renal cyst incision and drainage under flexible ureteroscope. The control group was under ultrasound guidance. The observation group was combined with MPR-CTU, the safety and efficacy was compared. There was no significant difference between the two groups in the success rate and the time of cyst treatment (P>0.05). The incidence of intraoperative and postoperative complications of the observation group was significantly lower than that of the control group. After 1 month follow-up, the total effective rate of the observation group was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion MPR-CTU technique combined with intraoperative ultrasonography to guide cyst incision and drainage under flexible ureteroscope for renal cystic disease has a high safety and efficacy, and it is worthy of clinical application.

Supernumerary Kidney Associated with Horseshoe Malformation: A Case Report and Review of Literature

We report a case of supernumerary kidney associated with horseshoe malformation. A 35-year-old man presented complaining of vague and intermittent left flank pain from few months ago. Ultrasonography of urinary tract showed bilateral hydronephrosis and was suggestive of the horseshoe anomaly. Further evaluation with Intravenous urography showed three renal moieties consisting of a horseshoe kidney and a malrotated right kidney cephalad to and fused with the right moiety of horseshoe kidney.