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Asian Journal of Urology Apr 2020Staghorn stones have always been a challenge for urologists, especially in some special situations, such as horseshoe kidney, ectopic kidney, paediatric kidney, and... (Review)
Review
Staghorn stones have always been a challenge for urologists, especially in some special situations, such as horseshoe kidney, ectopic kidney, paediatric kidney, and solitary kidney. The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications. The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function. Treatment methods for staghorn stones have developed rapidly, such as extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy and laparoscopy and open surgery. Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon. The decision should be made individually according to the circumstances of the patient. In this review, we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.
PubMed: 32257806
DOI: 10.1016/j.ajur.2019.12.014 -
Journal of Vascular Surgery Apr 2019Horseshoe kidney (HSK), referring to the abnormal fusion of the lower renal poles, represents one of the most common renal anomalies. One of its most significant... (Review)
Review
BACKGROUND
Horseshoe kidney (HSK), referring to the abnormal fusion of the lower renal poles, represents one of the most common renal anomalies. One of its most significant features is the anomalous vasculature, with a number of accessory renal arteries originating from the aorta, the mesenteric arteries, and even the iliac arteries supplying both the renal kidneys and the renal isthmus.
METHODS
A literature review was performed to identify and to present the most recent data regarding classification and imaging evaluation of HSK concomitant with abdominal aortic aneurysm (AAA). Furthermore, an in-depth analysis of both open surgical and endovascular repair is made for management of this rare medical condition.
RESULTS
The anomalous renal vasculature of HSK has led to the introduction of a number of classification systems, with Eisendrath's being currently the most commonly used. The concomitant presence of HSK in patients suffering from AAA plays a major role in preoperative planning, with a number of factors taken into consideration in deciding on either an open repair or an endovascular approach. Open repair requires careful decision-making between a transperitoneal and a left retroperitoneal approach to reach the aneurysm sac. In addition, technical points include the decision to divide the renal isthmus or not and the necessity of salvage or reimplantation of anomalous renal vessels. On the other hand, an endovascular approach requires careful preoperative imaging and evaluation of both the renal function and vasculature to decide on catheterization and salvage of accessory renal arteries or their exclusion.
CONCLUSIONS
The concomitant presence of AAA and HSK poses a challenge for the modern vascular surgeon, who must possess all required technical skills-both endovascular and open repair-to deal accordingly with this rarely encountered medical condition. Preoperative determination of the perfusion pattern is necessary for the treatment strategy.
Topics: Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Fused Kidney; Humans; Renal Circulation; Risk Factors; Treatment Outcome
PubMed: 30591298
DOI: 10.1016/j.jvs.2018.10.009 -
Archivos Espanoles de Urologia Jun 2021
Topics: Fused Kidney; Humans; Kidney; Kidney Calculi; Lithiasis
PubMed: 34080577
DOI: No ID Found -
International Braz J Urol : Official... 2022To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the...
PURPOSE
To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan).
MATERIALS AND METHODS
We analyzed seven 3-dimensional polyester resin endocasts of the kidney collecting system obtained from 6 fresh adult cadavers (4 with unilateral CUD and 2 with horseshoe kidney) and CT-scan reconstruction images of kidneys from 24 patients: 6 patients with HK, 8 with CUD and 10 patients without renal anomalies that were used as controls. We analyzed the spatial distribution of the calices, the infundibula diameters, the angle between the lower infundibulum and the renal pelvis (LIP) and the angle between the lower infundibulum and the inferior minor calyces (LIICA). Measurements of the width and length of the inferior infundibulum and the infundibula of the minor calyces, as well as the angles (LIP and LIICA) were made with the aid of the LibreOffice 6.3 software. The data were analyzed with the IBM® SPSS® Statistics.
RESULTS
There was no statistical difference in the inferior pole measurements between the groups with anomalies and the control group, both in polyester resin endocasts and CT-scan reconstruction images for LIP. When we compared the LIP in the CT-scan between HK versus CUD (p= 0.003), and HK versus the control group (p= 0.035), we observed statistical difference.
CONCLUSIONS
The knowledge of spatial anatomy of lower pole is of utmost importance during endourologic procedures in patients with kidney anomalies. In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.
Topics: Adult; Fused Kidney; Humans; Kidney; Kidney Calculi; Kidney Calices; Kidney Pelvis
PubMed: 35333487
DOI: 10.1590/S1677-5538.IBJU.2022.99.12 -
Cureus Nov 2022The presence of an extra (third) kidney is an unusual congenital anomaly of the urinary system (US), having less than a hundred cases reported globally. Owing to the...
The presence of an extra (third) kidney is an unusual congenital anomaly of the urinary system (US), having less than a hundred cases reported globally. Owing to the rare occurrence of this complex anomaly, the fused supernumerary kidney and horseshoe portion is very scarcely reported with unknown incidence. This paper presents a rare renal anomaly case of a fused supernumerary kidney with a horseshoe portion in a 41-year-old male who presented with fever, abdominal pain, and burning micturition. CT of the kidney urinary bladder showed non-rotation of the right kidney with a supernumerary malrotated horseshoe-shaped kidney and malrotated left kidney with features of acute pyelonephritis. The patient was managed with double J stenting and appropriate antibiotics till discharge.
PubMed: 36523683
DOI: 10.7759/cureus.31436 -
International Braz J Urol : Official... 2021
Topics: Fused Kidney; Humans; Kidney; Kidney Calculi; Pilot Projects; Printing, Three-Dimensional; Ureteroscopy
PubMed: 33848082
DOI: 10.1590/S1677-5538.IBJU.2021.99.10 -
IJU Case Reports Sep 2020
PubMed: 32914084
DOI: 10.1002/iju5.12201 -
Investigative and Clinical Urology Sep 2023Nephron-sparing surgery is the standard treatment for small renal mass (SRM). Nephron-sparing surgery has evolved from an open to a minimally invasive technique.... (Review)
Review
Nephron-sparing surgery is the standard treatment for small renal mass (SRM). Nephron-sparing surgery has evolved from an open to a minimally invasive technique. Robot-assisted partial nephrectomy (RAPN) is the latest technique in this field and is reported to be safe and feasible, showing oncologically and functionally superior or compatible results compared with open and laparoscopic partial nephrectomy for SRM. This is not limited to only SRM but also applies to large and complex renal masses and other challenging situations. RAPN showed good oncological and functional outcomes for ≥clinical T2 renal tumors, complex renal masses (PADUA score ≥10, RENAL score ≥10), hilar renal tumors, and multiple renal tumors. In addition, the outcomes of RAPN in these challenging cases were not inferior to those in conventional cases. RAPN could also be applied to a number of challenging cases in which the open technique was considered first. RAPN showed good results in patients with a solitary kidney, horseshoe kidney, and in repeat surgeries. Furthermore, RAPN could be safely performed on obese, elderly, and pediatric patients. Finally, this review evaluates efficiency and utility of RAPN based on the results of challenging cases of renal masses and to project the future of RAPN.
Topics: Aged; Humans; Child; Robotics; Nephrectomy; Kidney; Kidney Neoplasms; Laparoscopy
PubMed: 37668199
DOI: 10.4111/icu.20230121 -
Medical Journal, Armed Forces India Jul 2015
PubMed: 26265824
DOI: 10.1016/j.mjafi.2013.12.002 -
BMC Nephrology Aug 2021Horseshoe kidney (HSK) is a common congenital defect of the urinary system. The most common complications are urinary tract infection, urinary stones, and...
BACKGROUND
Horseshoe kidney (HSK) is a common congenital defect of the urinary system. The most common complications are urinary tract infection, urinary stones, and hydronephrosis. HSK can be combined with glomerular diseases, but the diagnosis rate of renal biopsy is low due to structural abnormalities. There are only a few reports on HSK with glomerular disease. Here, we have reported a case of PLA2R-positive membranous nephropathy occurring in a patient with HSK.
CASE PRESENTATION
After admission to the hospital due to oedema of both the lower extremities, the patient was diagnosed with nephrotic syndrome due to abnormal 24-h urine protein (7540 mg) and blood albumin (25 g/L) levels. Abdominal ultrasonography revealed HSK. The patient's brother had a history of end-stage renal disease due to nephrotic syndrome. Therefore, the patient was diagnosed with PLA2R-positive stage II membranous nephropathy through renal biopsy under abdominal ultrasonography guidance. He was administered adequate prednisone and cyclophosphamide, and after 6 months of treatment, urinary protein excretion levels significantly decreased.
CONCLUSION
The risk and difficulty of renal biopsy in patients with HSK are increased due to structural abnormalities; however, renal biopsy can be accomplished through precise positioning with abdominal ultrasonography. In the literature, 20 cases of HSK with glomerular disease have been reported thus far. Because of the small number of cases, estimating the incidence rate of glomerular diseases in HSK is impossible, and the correlation between HSK and renal pathology cannot be stated. Further studies should be conducted and cases should be accumulated to elucidate this phenomenon.
Topics: Diagnosis, Differential; Edema; Fused Kidney; Glomerulonephritis, Membranous; Humans; Image-Guided Biopsy; Kidney; Lower Extremity; Male; Middle Aged; Nephrotic Syndrome; Patient Care; Proteinuria; Receptors, Phospholipase A2; Treatment Outcome; Ultrasonography
PubMed: 34376183
DOI: 10.1186/s12882-021-02488-7