Han Wencong, Li Zhihua, Han Guanpeng, Xu Liqing, Li Xinfei, Fan Shubo, Wang Bing, Huang Chen, Cui Yuanshan, Zhang Zheng, Zhou Liqun, Yang Kunlin, Li Xuesong
Department of Urology, Peking University First Hospital, Beijing, China.
Institution of Urology, Peking University, Beijing, China.
Transl Androl Urol. 2024 Sep 30;13(9):2110-2118. doi: 10.21037/tau-24-142. Epub 2024 Sep 26.
Ectopic renal hydronephrosis is a relatively rare condition, with literature primarily consisting of scattered case studies. The ectopic kidney poses technical challenges to surgeons due to its structural and anatomical abnormalities. This study aims to share our initial experiences with minimally invasive pyeloplasty as a management approach for ectopic renal hydronephrosis in adult patients.
Between August 2018 and January 2023, six patients underwent minimally invasive pyeloplasty for ectopic kidneys. The patient cohort consisted of four individuals with pelvic kidneys, one with an iliac kidney, and one with an abdominal kidney. Among these, three cases were left-sided, two were right-sided, and one was isolated. The median patient age was 27 (range, 18-45) years. Four patients underwent robot-assisted laparoscopic pyeloplasty, while two underwent laparoscopic pyeloplasty. The median operative time was 134 (range, 63-240) minutes. After a median follow-up duration of 28.5 (range, 6-59) months, two patients required nephrectomy, with vesicoureteral reflux (VUR) and malrotation potentially contributing to surgical failure in these cases. The remaining four patients showed either stable or improved hydronephrosis and renal function. The overall operative success rate was 66.7%.
The rarity and anatomical variations of ectopic kidneys hinder the standardization of surgical approaches. The integration of three-dimensional (3D) virtual reconstruction and tailored surgical techniques contributes to enhanced outcomes in ectopic renal hydronephrosis cases. Furthermore, continued research and refinement of surgical approaches are needed.
异位肾积水是一种相对罕见的病症，文献主要由零散的病例研究组成。由于其结构和解剖异常，异位肾给外科医生带来了技术挑战。本研究旨在分享我们将微创肾盂成形术作为成人异位肾积水治疗方法的初步经验。
2018年8月至2023年1月期间，6例患者接受了异位肾微创肾盂成形术。患者队列包括4例盆腔肾患者、1例髂肾患者和1例腹肾患者。其中，3例为左侧，2例为右侧，1例为孤立肾。患者中位年龄为27岁（范围18 - 45岁）。4例患者接受了机器人辅助腹腔镜肾盂成形术，2例接受了腹腔镜肾盂成形术。中位手术时间为134分钟（范围63 - 240分钟）。中位随访时间为28.5个月（范围6 - 59个月）后，2例患者需要进行肾切除术，膀胱输尿管反流（VUR）和旋转不良可能是这些病例手术失败的原因。其余4例患者的肾积水和肾功能显示稳定或改善。总体手术成功率为66.7%。
异位肾的罕见性和解剖变异阻碍了手术方法的标准化。三维（3D）虚拟重建和定制手术技术的结合有助于提高异位肾积水病例的治疗效果。此外，还需要持续开展研究并改进手术方法。
