Crossed-Fused Renal Ectopia with a Solitary Ureter

Vol. 114, August Printed in U.S.A.

THE JOURNAL OF UROLOGY

Copyright © 1975 by The Williams & Wilkins Co.

CROSSED-FUSED RENAL ECTOPIA WITH A SOLITARY URETER NABIL K. BISSADA, FLOYD A. FRIED

AND

JOHN F. REDMAN

From the Division of Urology, University of Arkansas Medical Center, Little Rock, Arkansas, and the Division of Urology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina

ABSTRACT

A unique case is presented of a child with crossed-fused renal ectopia, in which the renal pelves joined into a common pelvis drained by a single ureter. The presence of intercommunicating pelves in a fused kidney is rare. 1 • 2 The presence of a single ureter draining the communicating pelves is even more rare, only 2 such cases having been reported.'· 4

to be supplied by 2 renal pedicles. Two collecting systems joined into a large saccular pelvis, which drained via a single ureter arising from the right side of the common pelvis (fig. 2). A dismembered pyeloplasty and resection of the redundant renal

FIG. 1. Arrow on IVP indicates ureter CASE REPORT

C. W., NCMH 259494, a 3-year-old boy, was evaluated because of gross, painless hematuria. Physical examination was unremarkable except for the presence of Sprengel's shoulder deformity. An excretory urogram (IVP) demonstrated no renal tissue on the left side. A single renal mass was seen on the right side with a double collecting system draining the mass. This duplex system opened into a large spherical mass just inferior to the kidney. A single ureter was visualized below this mass (fig. 1). A cystogram demonstrated a normal bladder and no reflux. On cystoscopy a single right ureteral orifice was seen. On exploration the single renal mass was found Accepted for publication February 7, 1975.

pelvis were done. The patient has maintained normal renal functions and stable pyelographic appearance 3 years postoperatively. DISCUSSION

Potampa and associates reported a combined tandem and horseshoe kidney in which the pelvis of the inferior component of the left kidney communicated across the midline with the pelvis of the right kidney. 1 Kron and Meranze reported a lump kidney in which the 2 pelves intercommunicated but were drained by separate ureters. 2 Kandzari and associates reported a lump kidney with a Y-shaped single ureter.' Cass and Vitko reported a crossed renal ectopia with intercommunicating pelves across the midline with 1 ureter

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that crossed the midline to enter the bladder on the opposite side. 4 Although our case shares the findand a single ing of intercommunicating ureter with the latter 2 cases, it has a unique anatomical configuration. Associated anomalies were common m the reinvolving the genitouriand skeletal systems. 3 • 4 The of

REFERENCES

L Potampaj P. B.j Hyman, lV.L D. and Catlow C. E.: An unusual renal anomaly: combined tandem and horseshoe kidney. J. Urol., 61: 340, 1949. 2. Kron, S. D. and Meranze, D. R.: Completely fused pelvic kidney. J. Urol., 62: 278, 1949. 3. Kandzari, S. J., Cha, E. M. and Milam, D. F.: Solitary fused kidney with a single Y-shaped ureter. W. Va. Med. J., 68: 181, 1972. 4. Cass, A. S. and Vitko, R. J.: Unusual variety of crossed renal ectopy with only one ureter. J. Urol., Hl7: 1056, 1972. 1

FIG. 2. Diagram of anatomic configuration of renal mass, collecting structures and vascular pedicles.