Right double inferior vena cava with obstructed retrocaval ureter is an extremely rare anomaly with only a few reported cases in the literature. To the best of our knowledge, this is the first case report describing ureteric repair by use of a single-incision laparoscopic technique. In addition, this report addresses the underlying surgical challenges of this repair and provides a brief review of the embryology of this anomaly. The "Santosh Postgraduate Institute ureteric tacking fixation technique" provides ease of end-to-end uretero-ureteric anastomosis in a single-incision laparoscopic surgery.
Humans ; Intraoperative Care/methods ; Intraoperative Complications/*prevention & control ; Laparoscopy/methods ; Magnetic Resonance Imaging ; Male ; *Retrocaval Ureter/diagnosis/physiopathology/surgery ; Treatment Outcome ; Urography/methods ; Urologic Surgical Procedures/*methods ; *Vena Cava, Inferior/abnormalities/surgery ; Young Adult

A patient with a complete right ureteral triplication presented with recurrent pyelonephritis and flank pain that was refractory to medical management. Evaluation showed that the atrophic upper-most renal moiety had been chronically obstructed and was associated with a dilated ureter. Intraureteral and intravenous indocyanine green (ICG) were used as real-time contrast agents intraoperatively to facilitate right robotic partial nephroureterectomy of the diseased system. Intraureteral ICG was used to accurately distinguish the pathologic ureter and associated renal pelvis from its normal counterparts. Intravenous ICG was used to assess perfusion in the right kidney and delineate the margins of diseased renal parenchyma.
Administration, Topical ; Adult ; Coloring Agents/administration & dosage ; Female ; Humans ; Indocyanine Green/*administration & dosage ; Infusions, Intravenous ; Nephrectomy/*methods ; Pyelonephritis/surgery ; Robotic Surgical Procedures/*methods ; Tomography, X-Ray Computed ; Ureter/*abnormalities/radiography/*surgery

STUDY DESIGN: Medical record-based survey. PURPOSE: To survey the overall incidence of the intra- and postoperative complications and sequelae, and to propose the preventive measures to reduce complications in the spinal tuberculosis surgery. OVERVIEW OF LITERATURE: There is no study focused on the surgery-related complications and sequelae, with some touching lightly on the clinical problems. METHODS: There were 901 patients in this study, including 92 paraplegics. One hundred eighty-six patients had no visible deformity, while those of 715 patients were visible. Six hundred fifty-nine patients had slight to moderate non-rigid kyphosis, and 56 had severe rigid kyphosis. Sixty-seven out of 92 paraplegics had slight to moderate non-rigid kyphosis, and 25 had severe kyphosis. There were 134 cervical and cervicodorsal lesions, 518 thoracic and thoracolumbar lesions, and 249 lumbar and lumbosacral lesions. Seven hundred sixty-four patients had primarily anterior surgeries, and 137 had posterior surgeries. Instrumentation surgery was combined in 174 patients. RESULTS: There were intra- and postoperative complications: direct large vessel and neurological injuries (cord, roots, nerves), late thrombophlebitis, various thoracic cavity problems, esophagus and ureter injuries, peritoneum perforation, ileus, wound infections, stabilization failure, increase of deformity and late adjacent joint and bone problems. Thrombophlebitis and sympatheticolysis symptoms and signs in the lower limbs were the most common complications related with anterior lumbar and lumbosacral surgeries. Kyphosis increased in 31.5% of the non-instrumented anterior surgery cases (42% in children and 21% in adults). CONCLUSIONS: The safe, effective and most familiar surgical procedure should be adopted to minimize complications and sequelae. Cosmetic spinal surgery should be withheld if functional improvement could not be expected.
Child ; Congenital Abnormalities ; Esophagus ; Humans ; Ileus ; Incidence ; Joints ; Kyphosis ; Lower Extremity ; Peritoneum ; Postoperative Complications ; Spine* ; Thoracic Cavity ; Thrombophlebitis ; Tuberculosis* ; Tuberculosis, Spinal ; Ureter ; Wound Infection

Crossed fused renal ectopia is a rare anomaly and may be associated with pelvic ureteric junction obstruction (PUJO). The L-shaped fusion variety is even rarer. We report such a case with a crossed fused ectopic pelvic kidney (L-type) with PUJO and its successful laparoscopic management. Through this report we emphasize the importance of adequate preoperative imaging and intraoperative details to avoid mishaps.
Adolescent ; Female ; Humans ; Kidney/*abnormalities ; Kidney Diseases/*complications/congenital/surgery ; Kidney Pelvis/*surgery ; Laparoscopy/*methods ; Reconstructive Surgical Procedures/*methods ; Ureter/*surgery ; Ureteral Obstruction/etiology/*surgery ; Urologic Surgical Procedures/methods

Crossed renal ectopia is a condition in which a kidney is located on the side opposite of its ureteral insertion. Ninety percent of crossed ectopic kidneys are fused to their ipsilateral uncrossed renal unit. Crossed renal ectopia without fusion is rare, with only 62 patients reported in the literature to date. These kidneys may suffer iatrogenic injury during an unrelated surgical intervention. The injury, unless self-limiting, may necessitate the removal of the ectopic kidney. We present a unique case of a dual injury, renal as well as ureteric, in a crossed ectopic kidney without fusion that was successfully managed without surgical excision.
Adult ; Choristoma/radiography/*therapy ; Humans ; *Iatrogenic Disease ; Kidney/*abnormalities/injuries/radiography ; Male ; Stents ; Tomography, X-Ray Computed ; Ureter/abnormalities/injuries/radiography

PURPOSE: Pediatric urolithiasis is uncommon in children but is a cause of significant morbidity and damage to the kidney. Although much information on adult urolithiasis is available in the literature, large studies on the pediatric population are still scarce. In this report, we review our experience with pediatric urolithiasis over 22 years at a tertiary referral center. METHOD: We retrospectively reviewed the records of children with newly diagnosed urolithiasis between January 1991 and May 2013. We assessed the age, sex, family history, initial symptoms, location of stones, underlying cause, stone analysis, treatment, and recurrence among the patients. RESULTS: In total, 137 patients (96 male, 41 female) were assessed. The age range was 0-17 years (mean age, 6.0 years). Forty-three (31%) children were aged <1 year, and 37% (16/43) had a history of intensive care unit (ICU) admission. Thirteen patients (9.5%) had a family history of stones. The most common symptoms at presentation among the patients were gross hematuria (56/137, 41%) and flank or abdominal pain (46/137, 34%). The stones were located in the kidney (85/137, 62%), ureter (29/137, 21%), bladder (2/137, 1.4%), and multiple locations (20/137, 15 %). Congenital abnormalities of the genitourinary (G-U) tract, with or without metabolic abnormality, or urinary tract infection (UTI) was detected in 26 children (19%). Ninety-one patients (66%) underwent metabolic examination, and 38% of these patients exhibited an abnormality. UTI, with or without abnormalities of the G-U tract, or metabolic abnormality was detected in 26 children (19%). Of the 35 stones analyzed, the majority were calcium stones (20/35, 57%), followed by infected stones (5/35, 14%), uric acid stones (4/35, 11%), carbonate apatite stones (3/35, 7%), cystine stones (2/35, 6%), and phosphate stones (1/35, 3%). Five patients (4%) required open procedures, with or without non-open procedures, whereas 77 patients (56%) were managed conservatively; the remaining 55 patients (40%) received some other form of intervention. Eighteen patients (13%) had stone recurrence during the follow-up period. CONCLUSIONS: Pediatric urolithiasis is commonly associated with abnormalities of the G-U tract and/or metabolic disorders and/or UTI. Half of the patients will pass their stones spontaneously, and all the techniques of minimally invasive surgery are applicable in the treatment of children with stones. As the recurrence rates are high among this population, long-term follow-up is recommended and the complete clearance of stones is important.
Abdominal Pain ; Adult ; Apatites ; Calcium ; Carbon ; Child ; Congenital Abnormalities ; Cystine ; Follow-Up Studies ; Hematuria ; Humans ; Intensive Care Units ; Kidney ; Male ; Recurrence ; Referral and Consultation ; Retrospective Studies ; Ureter ; Uric Acid ; Urinary Bladder ; Urinary Tract Infections ; Urolithiasis*

Genetically engineered mice have provided much information about gene function in the field of developmental biology. Recently, conditional gene targeting using the Cre/loxP system has been developed to control the cell type and timing of the target gene expression. The increase in number of kidney-specific Cre mice allows for the analysis of phenotypes that cannot be addressed by conventional gene targeting. The mammalian kidney is a vital organ that plays a critical homeostatic role in the regulation of body fluid composition and excretion of waste products. The interactions between epithelial and mesenchymal cells are very critical events in the field of developmental biology, especially renal development. Kidney development is a complex process, requiring inductive interactions between epithelial and mesenchymal cells that eventually lead to the growth and differentiation of multiple highly specialized stromal, vascular, and epithelial cell types. Through the use of genetically engineered mouse models, the molecular bases for many of the events in the developing kidney have been identified. Defective morphogenesis may result in clinical phenotypes that range from complete renal agenesis to diseases such as hypertension that exist in the setting of grossly normal kidneys. In this review, we focus on the growth and transcription factors that define kidney progenitor cell populations, initiate ureteric bud branching, induce nephron formation within the metanephric mesenchyme, and differentiate stromal and vascular progenitors in the metanephric mesenchyme.
Animals ; Body Fluids ; Congenital Abnormalities ; Developmental Biology ; Epithelial Cells ; Gene Expression ; Gene Targeting ; Hypertension ; Kidney ; Kidney Diseases ; Mesoderm ; Mice ; Morphogenesis ; Nephrons ; Phenotype ; Stem Cells ; Transcription Factors ; Ureter ; Waste Products

We present a case of vaginal ectopic ureter with ipsilateral partial duplication of the upper ureter (Y-type ureter), ipsilateral hypoplastic pelvic kidney and bicornuate uterus in a 20-year-old woman who presented with mild urinary incontinence since infancy. Ultrasonography, computed tomography and intravenous pyelography examination showed a left kidney with no evidence of a right kidney. Cystourethroscopy showed absence of the right hemitrigone. Magnetic resonance (MR) urography demonstrated the presence of a bicornuate uterus, an ectopic dysplastic right kidney in the pelvic cavity, and a right ureter that terminates in the vaginae fornix. The patient underwent right nephroureterectomy and urinary continence was restored completely. Although congenital malformations of the urinary tract are frequently associated with genital tract abnormalities, to best our knowledge, this is the first report of the coexistence of all of these anomalies in an individual. Our report also highlights the importance of MR urography in the diagnosis of such rare and complex anomalies.
Female ; Humans ; Kidney ; abnormalities ; pathology ; Kidney Diseases ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Ureter ; abnormalities ; pathology ; Urinary Incontinence ; etiology ; Uterus ; abnormalities ; pathology ; Vagina ; abnormalities ; pathology ; Young Adult

Horseshoe kidney and retrocaval ureter are uncommon congenital anomalies of the genitourinary system that are easily diagnosed by typical imaging features. Both anomalies presenting in one patient is a rare disease characterized by isthmus of horseshoe kidney between the abdominal aorta and inferior vena cava. The clinical diagnosis and treatment of horseshoe kidney with retrocaval ureter remain a challenge. Here, we reported a case of a 44-year-old man with the two anomalies who was preoperatively diagnosed by unenhanced computed tomography scanning immediately after retrograde pyelography. The literatures on such combined anomalies are reviewed and the diagnostic evaluation and surgical management of this rare entity are discussed.
Adult ; Humans ; Kidney ; abnormalities ; surgery ; Male ; Ureter ; abnormalities ; surgery

OBJECTIVETo explore the surgical strategy for ectopic kidney and evaluate the clinical outcomes.

METHODSFrom January 2000 to October 2009, 35 cases of ectopic kidney were treated surgically in our hospital. Definite diagnoses were established in all the cases by ultrasound, intravenous urography (IVU), cystoscope, CT, magnetic resonance urography (MRU) and radionuclide imaging before the surgery. In these patients, 26 had ipsilateral ectopic ureteral orifice (including 5 with bilateral duplicated kidneys and ureter), 9 had moderate or severe hydronephrosis (including 3 with ectopic kidney calculi), and 24 had dysplastic kidney (24/35). All the patients underwent operations, including 26 with ectopic nephrectomy, 7 with ectopic ureterovesical reimplantation, and 3 with ectopic renal pelvis incision.

RESULTSThe clinical effect was satisfactory in all the cases during the follow up of 7 to 29 months.

CONCLUSIONAppropriate surgical approaches according to the concurrent deformities and complications can achieve good clinical results in patients with ectopic kidneys.

Abnormalities, Multiple ; diagnosis ; surgery ; Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Kidney ; abnormalities ; surgery ; Nephrectomy ; methods ; Ureter ; abnormalities ; surgery ; Young Adult