Ultrasound-Guided Percutaneous Nephrolithotomy for Staghorn Stone in Crossed Fused Ectopic Pelvic Kidney

Abstract

Introduction and Objectives:

Crossed fused ectopia is a rare congenital renal anomaly that can be associated with concomitant ureteropelvic junction obstruction, malrotation, and abnormal or aberrant renal vasculature predisposing to obstructive changes, infection, calculi, and renal damage. Due to anomalous anatomy, surgical intervention, especially minimal invasive approaches, can be more challenging. In this study, we present our technique of percutaneous nephrolithotomy (PCNL) in a crossed fused pelvic ectopic kidney and present our experience of PCNL in anomalous positioned ectopic kidneys.

Materials and Methods:

A 25-year-old female presented with right flank pain, fever, and pyuria. On evaluation, she had a crossed fused ectopic pelvic kidney with right pelvic staghorn calculus and moderate hydronephrosis. She underwent our technique of ultrasound-guided modified supine percutaneous renal access with bowel displacement. Purulent urine was drained with a nephrostomy tube and then single-stage PCNL was performed 3 days later. At our center, we did ultrasound guidance access and PCNL in 6 cases of the total 11 ectopic pelvic kidneys.

Results:

Stone was cleared completely on follow-up imaging and postoperative nephroscopy. The patient had an uneventful recovery and was discharged on postoperative day 5. She has remained symptom free in 3 years of follow-up. Totally, in 6 ectopic pelvic kidney PCNL (out of total 11 cases), we could achieve complete clearance in all cases. There was no complication that was attributed to ultrasound guidance access in this group. We also did laparoscopic guidance PCNL, retrograde intrarenal surgery, and open surgery for ectopic pelvic kidney stones in two, two, and one case, respectively.

Conclusions:

With some technical modifications, ultrasound-guided PCNL is a safe, feasible, and effective modality as an alternative to open and laparoscopic surgery in select cases for stones in crossed fused ectopic pelvic kidneys with minimum morbidity and complete stone clearance.

No competing financial interests exist.

Runtime of video: 7 mins