Kidneys and ureters
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The fetal kidney arises in the pelvis and ascends to attain its normal position. If this process fails to any degree, the kidney ends up being in a lower-than-normal position. During their ascent, the renal pelvis also rotates from facing anteriorly to facing more medially. The most common anomaly is for the renal pelvis to face anteriorly and the more ectopic the kidney, the more severe is the rotational abnormality. In the majority of cases of renal ectopia, both kidneys are fused. In crossed renal ectopia (Figure76.2), both kidneys are fused and are on the same side - one of the ureters, therefore, crosses the midline to enter the bladder on the correct side of the trigone.
Developmental and positional anomalies of the kidney
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Abnormal cephalad migration of the kidney is thought to occur in approximately 1 : 1000 people, with equal sex distribution, according to autopsy studies. Ectopic kidneys are found in the following locations (in order of decreasing frequency): pelvic (may be a sole kidney), iliac, crossed fused (1 : 7000) and thoracic (1 : 16000, can be associated with thoracic anomalies of the heart, lung and diaphragm). The ectopic kidney is often small, lobulated and abnormally rotated. In combination with abnormal vasculature, there is a higher risk of pelviureteric junction obstruction.
The kidneys, urinary tract and prostate
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
One kidney (usually the left) fails to ascend normally and remains in the pelvis. There may be contralateral renal agenesis or other anomalies. The condition is very rarely bilateral. The ectopic kidney is usually malrotated, with an anteriorly facing renal pelvis and a short ureter, although the ureteric orifice in the bladder is normal. Most cases are asymptomatic, but, as with horseshoe kidneys, the impaired drainage can cause problems.
Clinical Presentations and Diagnostic Imaging of VACTERL Association
Published in Fetal and Pediatric Pathology, 2023
Gabriele Tonni, Çağla Koçak, Gianpaolo Grisolia, Giuseppe Rizzo, Edward Araujo Júnior, Heron Werner, Rodrigo Ruano, Waldo Sepulveda, Maria Paola Bonasoni, Mario Lituania
Renal anomalies occur in approximately 50-80% of patients with VACTERL association [32,33]. The renal abnormality spectrum ranges from renal agenesis to horseshoe kidney and MCDKD, which may be also associated with limb defects such as oligodactyly of the foot [50] (Figures 11 and 12), and crossed renal ectopia may be seen (Figures 13 and 14). In some studies, the most common renal manifestation seen in patients with VACTERL association is renal agenesis [51,52] (Figures 15 and 16). In a cohort study conducted by Cunningham et al. [53], vesicoureteral reflux (VUR) in addition to a structural defect was the most common renal anomaly, followed by renal agenesis. Stenosis of the urethra with an enlarged bladder, resembling lower urinary tract obstruction, can also be observed [54]. Urinary anomalies represent a series of diseases capable of causing major morbidity, some of which can be life-threatening. These anomalies often go unrecognized or overlooked, affecting the child’s growth and the future chance of transplant success [55]. In the postnatal period, examination with a voiding cystourethrogram may be required in cases with VUR [5]. Renal agenesis can be diagnosed using US and/or MRI. Renal agenesis and renal artery absence, hypertrophy of the contralateral kidney on US, and MRI with the ipsilateral adrenal gland “lying-down” in the pelvis are recognized MRI diagnostic clusters [56].
Is the 4.5-F ureteroscope (Ultra-Thin) an alternative in the management of ureteric and renal pelvic stones?
Published in Arab Journal of Urology, 2018
In all, 41 patients treated with a 7.5–9.5F semi-rigid URS (Karl Storz, Tuttlingen, Germany) with a mean (SD) age of 50.66 (14.85) years (Group 1); and 33 patients treated with a 4.5–6.5F URS (Ultra-Thin, Richard Wolf GmBH, Knittlingen, Germany) with a mean (SD) age of 49.09 (12.26) years (Group 2) were prospectively included in the study. This study followed the tenets of the Declaration of Helsinki and the protocol was approved by the Local Ethics Committee. All patients were informed about the goals of the study and written informed consent was obtained. Exclusion criteria were: ipsilateral ureteric stricture, multiple stones, horseshoe or ectopic kidney, previous ureteric intervention including ureteroscopy or ureteric stent insertion, and active urinary infection. The characteristics of the patients are shown in Table 1.
A cross-sectional study of the genital duct and renal anomalies in Egyptian cases of congenital absence of the vas deferens
Published in Human Fertility, 2022
Taha AbdElnaser, Yasser Ibrahem Elkhiat, Hatem Mohamed El-Azizi, El Fatah, Mohamed Abd, Ahmed Mahmoud Elshibany, Sameh Fayek GamalEl Din
Congenital absence of the vas deferens (CAVD) is a relatively rare bilateral (CBAVD) or unilateral (CUAVD) anomaly that may contribute to male infertility. CBAVD is the most common cause of extra-testicular ductal system obstruction affecting about 1–2% of infertile males, 4–17% of males with azoospermia, and 25% of males with obstructive azoospermia (Mittal et al., 2017). However, the real prevalence of CUAVD is unclear, as some men with CUAVD may have normal fertility status and no symptoms (Akinsal et al., 2018). Each mesonephric duct (Wolffian duct) is the source of two physically isolated derivatives: the ipsilateral ureteral/renal system and most of the ipsilateral genital duct (Akinsal et al., 2018). Previous studies indicated that congenital absence of the male genital duct system could occur separately or in combination with renal agenesis or malformations (Esteves, 2016). CAVD is generally identified during the evaluation of infertility or as an accidental finding at the time of a surgical procedure of the urogenital zone, such as orchidopexy or vasectomy (Ong et al., 2017). CAVD can be unilateral or bilateral and partial or complete, and it can be associated with epididymal hypoplasia or other abnormalities including seminal vesicles and ejaculatory duct anomalies and cryptorchidism (Khan & Novell, 2001). Although CAVD is usually not difficult to diagnose, it may be missed due to a poor (or no) physical examination taking place. Renal agenesis is the most common renal anomaly that can be seen with CAVD (Salwan & Abdelrahman, 2017). Nevertheless, several publications documented many other associated anomalies including ectopic kidney, multicystic kidney, horseshoe kidney and malrotation of the solitary kidney (Salwan & Abdelrahman, 2017).
Related Knowledge Centers
- Thorax
- Pelvic Cavity
- Kidney
- Crossed Renal Ectopia