RIRS A Boon for The Crossed Ectopic Non fused Kidney Calculi Patients First Case Report

Abstract

Introduction : The incidence of ectopic kidney in autopsy series is around 1 in 900 otherwise it is 1 in 3000. There are various treatment modalities that can be utilised to treat these renal calculi e.g., extracorporeal shock wave lithotripsy, laproscopy assisted per-cutaneous nephrolithotomy, retrograde intra-renal surgery using the flexible ureteroscope, laproscopic/robotic pyelolithotomy and open surgery. We here describe a case of RIRS for stone in the pelvis of ectopic left kidney located on the right side just below the right kidney, it was crossed but not fused. To the best of our knowledge, this is first such case to be reported in crossed non-fused ectopic kidney. Case Report : A 33 years young male came with complaints of intermittent pain right loin for 2-3 months, mild initially but severe for last 24 hours. Physical examination suggested mild tenderness right iliac fossa. Ultrasonography and intravenous pyelography suggested ectopic left kidney located on right side below the right kidney in the right iliac fossa and not fused or attached to the right kidney with a large 21mm pelvic calculus with mild hydronephrosis. He later underwent retrograde intra-renal surgery where stone was completely lased and double J stent was kept at the end of the procedure. Results : Complete stone clearance was confirmed visually and under c-arm. Post operative USG and x-ray KUB showed no residual calculus. Patient was discharged on second postop day. There were no post-op complications. The double J stent was removed after two weeks. Conclusion : RIRS is a very good option to treat stones in an ectopic kidney. It may require more than one session sometimes, but considering the minimal invasive nature, the bothersome is less. Disposable ureteroscopes have further revolutionised the armamentarium of the urologist, who can now offer a personalised treatment plan for each patient. Keywords : RIRS, ectopic kidney, crossed ectopic non-fused kidney, stone in ectopic kidney, minimal invasive laser surgery