Korean J Urol.  2009 May;50(5):512-515.

Retroperitoneoscopic Nephrectomy for a Horseshoe Kidney with Unilateral Severe Hydronephrosis and Ureteral Hypoplasia

• Lee JW
• You SH
• Han DY
• Jeong HJ
• Choi DY
• Oh YK

Abstract

A horseshoe kidney is the most common renal fusion anomaly. It is well known that horseshoe kidneys may be associated with many urological problems, including calculi, vesicoureteral reflux, and ureteropelvic junction obstruction. However, a horseshoe kidney with unilateral severe hydronephrosis and ureteral hypoplasia is very rare. We report an 11-year-old female who underwent a retroperitoneoscopic nephrectomy for a horseshoe kidney with severe hydronephrosis and unilateral ureteral hypoplasia.

Keyword

Hydronephrosis; Ureter

MeSH Terms

Calculi
Child
Female
Humans
Hydronephrosis
Kidney
Nephrectomy
Ureter
Vesico-Ureteral Reflux

Figure

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  Fig. 1 Imaging studies. (A) and (B) enhanced computed tomography scan, transverse and coronary images, showing a horseshoe kidney with very large hydronephrosis of the left kidney. (C) The 99mTc-MAG3 renal scan showed decreased renal uptake. (D) Insertion of a percutaneous nephrostomy was performed to reduce the size of the hydronephrosis and mark the site so that it could be easily seen during the operation.

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  Fig. 2 Intraoperative retroperitoneoscopic nephrectomy procedure for a horseshoe kidney with severe hydronephrosis due to unilateral ureteral hypoplasia. (A) The percutaneous nephrostomy tube was checked. (B) The Gerota's fascia was opened and the kidney was freed. (C) Thread-like hypoplasia of the ureter was seen. (D) Renal arteries and veins were clipped and cut. (E) The isthmus was divided by ultrasonic scissors (SonosurgⓇ). (F) The specimen was put into a LapSacⓇ and extracted.

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  Fig. 3 Gross findings. (A) Excised kidney showing severe hydronephrosis. (B) Distal ureteral hypoplasia (arrow).

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  Fig. 4 Pathologic findings. (A) H&E, x100, Nonfunctioning kidney with chronic inflammation. (B) H&E, x200, A few normal nephrons (arrow).

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