V6-10: Ultrasound-guided Percutaneous nephrolithotomy for Staghorn Stone in Crossed-Fused Ectopic pelvic Kidney

Video

Introductions and Objectives
Introduction ; 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. Here we present our technique of PCNL in a crossed-fused pelvic ectopic kidney.

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 percuataneous renal access with bowel displacement. Purulent urine was drained with a nephrostomy tube and then single stage PCNL was performed 3 days later.

Results
Stone was cleared completely on follow up imaging and postoperative nephroscopy. She had uneventful recovery and was discharged on postop day 5. She has remained symptom free in 3 years of follow up.

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.

Funding: none