Abstract
Clinical History:
A 52-year-old female presented to the Emergency Department with acute onset of right flank pain. She did not have any urinary symptoms nor signs of infection. CT Intravenous pyelogram revealed a peri-nephric urinoma, grossly dilated right kidney with a filling defect in the renal pelvis and a possible calyceal diverticulum. Emergently she underwent a cystoscopy and ureteric stent insertion. The intraoperative pyelogram revealed a filling defect in the renal pelvis. A few weeks later, she underwent a ureteropyeloscopy, which demonstrated a benign appearing mass arising from the calyx.
Physical Exam:
Her vitals were within normal range. She had renal angle tenderness on palpation.
Diagnosis:
Biopsy taken during the initial pyeloscopy revealed a benign polyp. Following complete excision of the lesion, histopathology revealed a mixed epithelial and stromal tumor of the kidney (MESTK). MESTK are rare benign renal tumor.
Intervention:
Following pyeloscopy, the mass was deemed too large to excise ureteroscopically. Following the confirmation of benign disease a robotic assisted laparoscopic pyelotomy, excision and pyeloplasty was planned. Given the lesion involved the collecting system, a pyelotomy was performed. The lesion was then excised in its entirety and the collecting system was reconstructed during the pyeloplasty. MESTKs are managed by either nephron-sparing surgery or complete nephrectomy. To our knowledge this is the first MESTK that is managed with robotic surgery. Allowing for nephron-sparing surgery, especially as this lesion involved the collecting system.
Follow-Up/Outcomes:
The patient’s postoperative course was uneventful. At 6-week follow-up, she was recovering well.
Patient Consent Statement:
Informed written consent was obtained from the patient and has been archived.
The author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.
Financial and competing interest disclosures:
The authors report no conflicts of interest.
Author Disclosure Statement:
There are no commercial associations during the last 3 years that might create a conflict of interest in connection with this video.
Runtime of video: 4 min 18 sec.
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