BILATERAL VESICO-URETERAL REFLUX IN PATIENT WITH CROSSED RENAL ECTOPIA AND FUSION TYPE A


Submitted: 16 May 2012
Accepted: 16 May 2012
Published: 16 May 2012
Abstract Views: 1281
PDF: 1008
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Authors

  • A.L Bulotta Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.
  • M. Pavone Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.
  • G. Di Maggio Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.
  • A. Burgio Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.
  • E. Cerchia Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.
  • G. Giannotti Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.
  • M. Messina Division of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy.
Introduction. Crossed renal ectopia with fusion is a very rare congenital anomaly and the reported incidence varies between 1:1000 and 1:7000. The kidney is located on the opposite site of the mid- line from where the ureter enters the bladder. Eighty-five percent of crossed renal ectopia kid- neys are fused from below to the normally located kidney. This anomaly is more frequent for left kidney and it’s associated with vesico-ureteral re- flux (VUR) in 25-70% of cases. We report the management of a six-years-old patient with Pluri- malformative Syndrome, trisomy p16 and mono- somy q2, crossed renal ectopia with fusion type A and bilateral vesico-ureteral reflux (grade IV in the right kidney and grade III in the left).Materials and Methods. A 6-year-old boy was ammitted to our hospital for UTI in plurimalfor- mative syndrome characterized at birth by cleft palate, macrocephaly, congenital clubfeet, twisted right arm, congenital dysplasia of the hip, balanic hypospadias, bilateral inguinal hernia, right renal agenesis and epilepsy tonic-clonic. MRI revealed a fusion of the ectopic kidney with the left ortho- topic kidney (crossed renal ectopia with fusion type A). Voiding cystography showed a dilatated ureter of the crossed ectopic kidney passing across the midline and of the left ureter, and a bilateral vesico-ureteral reflux ( grade IV VUR in the right kidney and grade III VUR in the left). For this reason bilaterally endoscopic subureteral infiltra- tion was performed with Deflux ( 0.3 cc for side). Results. Patient was discharged in third day and he took antibiotic for one week. There weren’t complications like fever, obstruction or UTI. Fol- low-up after 1 month is normal and there weren’t UTI. Conclusion. Generally the outcome of patients with fused crossed renal ectopia is good. Presence of associated pathology likeVUR, could lead to a progressive deterioration of renal function. There- fore, in patient with uninhabited kidney area and UTI, it’s very important a carefull radiological in- vestigation to exclude a renal ectopy complicated by RVU and especially to realize an appropriate treatment strategy before the patient develops a chronic renal failure. Endoscopic infiltration with Deflux, in our case, was detected a viable surgical technique for its minimally invasiveness and also for its efficacy with a relatively short hospital stay.

Bulotta, A., Pavone, M., Di Maggio, G., Burgio, A., Cerchia, E., Giannotti, G., & Messina, M. (2012). BILATERAL VESICO-URETERAL REFLUX IN PATIENT WITH CROSSED RENAL ECTOPIA AND FUSION TYPE A. Journal of the Siena Academy of Sciences, 2(1), 54. https://doi.org/10.4081/jsas.2010.483

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