Pyeloplasty for the treatment of ectopic renal hydronephrosis in adults: a case series of six patients.

Background: 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.

Case description: 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%.

Conclusions: 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.