P–350 Utilizing indocyanine green (ICG)-enhanced fluorescence to localize the ureter during robotic surgery for DIE and a concomitant crossed renal ectopia

Study question Feasibility of (ICG)-enhanced fluorescence in visualizing the atypical course of the ureter during surgery for (DIE) of pelvic sidewall with a concomitant crossed renal ectopia. Summary answer Near-infrared fluorescence after transurethral injection of ICG enables localization of the ureter during surgery, thus facilitating complete excision of the lesions while enhancing patient’s safety. What is known already Existing case series refer to the transurethral injection of ICG and visualization under near-infrared (NIR) light during robotic surgery for real-time delineation of the ureter, which helps to prevent iatrogenic ureteral injury during complex surgery. The ICG reversibly stains the inside lining of the ureter by binding to proteins on urothelial layer. The consequent green fluorescence allows its identification throughout the entire case. The presented case of a DIE of pelvic side wall along with an ipsilateral concomitant crossed renal ectopia (residual function 27%) resembles an utmost challenge for surgery. To our knowledge no similar case has been reported in literature. Study design, size, duration Demonstration of the Robotic technique by means of a step-by-step tutorial Participants/materials, setting, methods 29-year-old patient referred after preceding laparoscopic surgery for DIE of left pelvic sidewall and abortion of surgery due to lack of accessibility/ severeness of the case. We performed renal scintigraphy, pelvic MRI and urological consultation. Surgery was performed using an XI-da-Vinci robotic system. After cystoscopic placement of mono-Js we injected 4 ml. of ICG-solution (2,5 mg/ml). Visualization of the pelvic kidney was achieved 4 minutes after injection and of the complete ureter after 7–8 Minutes. Main results and the role of chance The robotic surgery could be completed safely and achieve a complete resection of the DIE of the pelvic sidewall including adhesiolysis of a broadly adherent bowel, opening of the rectovaginal space, ureterolysis of the distal portion of the ureter, partial excision of the left sacrouterine ligament and deperitonealization of the pelvic sidewall. Postoperative controle revealed normal renal function and an adequate postoperative course. Limitations, reasons for caution ICG cannot be used in patients with iodine allergy. Wider implications of the findings: Our report underlines the possibility to utilize indocyanine green (ICG)-enhanced fluorescence to localize the ureter during complex surgery for DIE, even in cases with atypical anatomy of the lower urinary tract. Trial registration number Not applicable

Crossed renal ectopia with an unusual form of fusion (inverted U shape) managed by novel approach - laparoscopic ureterocalicostomy. A case report

Herein we present a case of crossed renal ectopia with an unusual type of fusion, discovered incidentally in a 11-year-old girl presented with recurrent urinary tract infections. Both kidneys were located on the right side of the body fused in their upper poles only, forming an inverted U shape. After reviewing the published data on this topic, we found that most of the described anomalies were within the six well-known types of fusion anomalies. This child had an unusual clinical presentation of severe hydronephrosis of the orthotopic kidney. A unique surgical technique to correct the pathology to be able to preserve the residual mass of that kidney was performed.

Crossed renal ectopia with fusion in a female feline: case report

ABSTRACT A 3 year old female feline of mixed breed was sent to the diagnostic imaging sector under suspicion of bleeding due to ovariohysterectomy. An abdominal ultrasonography was performed to confirm the initial suspicion. However, no signs of bleeding were found, instead it was observed that the left renal silhouette had two pelvises and was elongated and larger than normal. The right kidney was not found. Excretory urography was requested to evaluate the condition of the ureters. The final diagnosis was crossed renal ectopia with fusion in an asymptomatic cat with no changes in renal function.

Cake kidney-complete crossed fused ectopia

Cake kidney or complete crossed fused renal ectopia refers to complete fusion of both kidneys and remain on the same side of the midline. It is due to failure of normal renal ascent during embryogenesis with fusion of kidneys within the renal pelvis.1,2 We present a case of 18years old male with heaviness in right lumbar region and CECT was done which showed complete crossed renal ectopia.3

A rare case of pelviureteric junction obstruction in the uncrossed kidney of a crossed fused renal ectopia

Crossed renal ectopia with fusion is an extremely rare congenital anomaly with few reported cases of pelviureteric junction obstruction, which often involves the crossed-over kidney. To our knowledge, we describe the second case in literature to report an uncrossed kidney with pelviureteric junction obstruction and giant hydronephrosis, which obstructs the pelviureteric junction of the crossed-over kidney. The grossly hydronephrotic kidney was found to be poorly functioning and an aberrant crossing vessel was considered to be potentially involved, raising both diagnostic and management challenges. By reporting this case, we aim to stress the importance of adequate mapping collecting systems, drainage patterns and vascular supply in such crossed fused anomalies.

Crossed Fused Ectopia of Kidney – An Account of Tertiary Healthcare Center Experience

Background: Crossed renal ectopia with fusion is the abnormal migration of the kidney to the opposite side of the insertion of the ureter to the bladder. It is the second most common congenital anomaly of the kidney and urinary tract preceded by horseshoe kidney. The following article serves to highlight the anomaly in a conglomeration of 17 unique cases, managed in our tertiary care centre over a period of 5 years. Materials and Methods: This is a descriptive study analysing the demographic features and the management of seventeen patients diagnosed with crossed renal ectopia with fusion during the period January 2012 to January 2017. Radiological modalities of investigation were modified as per the anomaly. The management plan was devised keeping in mind, the essence of preserving the functional unit. Results: Of the seventeen cases, nine patients were symptomatic and eight were asymptomatic. The most recurring crossed renal ectopia with fusion was L- shaped (n=6), disc shaped (n=6) sigmoid shaped (n=2), inferior (n=1), cake shaped (n=1) and superior ectopia (n=1). Left to right ectopia (n=9) was more common than right to left (n=8). Three patients had a solitary crossed ectopia. Out of nine symptomatic patients, six patients underwent surgical procedures, the remaining three were treated conservatively and advised regular biannual follow-up with imaging. Conclusion: The management of crossed renal ectopia with fusion is individualised according to the underlying urological anomaly and its sequelae. Importance is given to preserve the renal function whenever possible. Reconstructive surgeries like pyeloplasty, ureteric reimplantation, boari flap can salvage some function in these units.