Crossed fused renal ectopia: Challenges in diagnosis and management

Abstract

Aim:Crossed fused renal ectopia is a rare congenital malformation, which is reported to be usually asymptomatic but may have varied presentations. This survey was conducted to study the clinical profile and the challenges posed in the management of this entity.Materials and Methods:Retrospective analysis of 6 patients diagnosed to have crossed fused renal ectopia during 1997-2010. The diagnosis was confirmed during surgical exploration in one patient. In one patient it was detected on antenatal ultrasonography and in the other 4 patients it was detected during investigations for abdominal pain, abdominal mass, anorectal malformation and urinary tract infection.Results:The left moiety was crossed and fused with the right moiety in 4 cases. Ultrasonography was found to be a good screening investigation with useful diagnostic contributions from CT scans, radionuclide scintigraphy and magnetic resonance urography. Micturating cystourethrography revealed presence of VUR in 4 cases, 3 of whom have undergone ureteric reimplantation. Two patients required pyeloplasty for pelviureteric junction obstruction; in one of these patients the upper ureter was entrapped in the isthmus. In one patient, a non-functioning moiety resulted in nephrectomy. All children were asymptomatic at last follow-up with stable renal functions.Conclusions:Crossed fused renal ectopia was detected in most patients during investigation for other problems. It was found more commonly in boys. The left moiety was crossed to the right in the majority of cases. Associated urological problems were found in most cases and required the appropriate surgical management.

Congenital Renal Fusion and Ectopia in the Trauma Patient

“…Its incidence is roughly 1 : 2000 and also has an increased incidence of infection, obstruction, and stone formation [5]. Like horseshoe kidney, crossed renal ectopia is more common in males [4, 5]. In renal ectopia, the left kidney is frequently crossed to the right side, as presented in case two [5].…”

Management of ureteral obstruction in crossed fused renal ectopia: A case report

“…4 Left to right ectopia is more common than right to left. There are several classifications of crossed fused renal ectopia depending on the orientation of the fused kidneys including: unilateral fused kidney with inferior or superior ectopia, sigmoid kidney, lump kidney, disc kidney, and L-shaped kidney.…”

“…6 Although crossed fused renal ectopia is often discovered incidentally while investigating other genitourinary issues, approximately half of all patients experience complications, such as hydronephrosis, nephrolithiasis, and frequent urinary tract infections. 4 While there is no primary treatment, Bhojwani et al…”

“…There are several classifications of crossed fused renal ectopia depending on the orientation of the fused kidneys including: unilateral fused kidney with inferior or superior ectopia, sigmoid kidney, lump kidney, disc kidney, and L-shaped kidney. 4 The abnormality is the result of inappropriate development of the ureteric bud and metanephric blastema between 4 to 8 weeks gestation. It is hypothesized to be associated with caudal rotation of the embryo, which is supported by increased prevalence in patients with scoliosis.…”

“…4 Ureteral obstruction due to pelvic malignancy, notably prostate cancer, is common in the later stages of advanced disease. Patients that develop bilateral obstruction may develop hydroureteronephrosis and progressive renal failure.…”