Aim of the studyHorseshoe kidney is one of the most common genitourinary system anomalies. The frequency of its occurrence in the whole population is about 0.25%. In the available literature more than 200 cases of such tumour-defect coexistence have been described. Purpose of this study was to present the possibilities of using various methods of surgical treatment of tumors localized in the horseshoe kidney.Material and methodsIn the years 2004–2007 five patients were diagnosed and treated for tumours in horseshoe kidneys. Ultrasonography, computed tomography, urography and nuclear magnetic resonance were applied in the diagnosis. During the treatment both open operations and modern methods of treating tumours with a diameter less than 40 mm (nephron sparing) were used.ResultsRenal cell carcinoma (RCC) was confirmed in all the patients.ConclusionsOur observations confirm the fact that RCC is the most often diagnosed tumour in horseshoe kidneys. The prognostic factors are the same as in the case of tumours of the kidneys without any abnormalities. The diagnosis is based on applying the modern methods of imaging and in the treatment it is possible to apply the modern, non-invasive methods.
Analysing the data available in the literature, contemporary methods of treatment of nephrolithiasis are limited to the methods of minimally invasive percutaneous nephrolithotomy (PCNL) and ureterorenoscopic lithotripsy (URSL), not excluding their use in the presence of developmental abnormalities and kidney impairment only. Minimally invasive methods have become standard procedures. A complement to ineffective URSL and PCNL treatment is extracorporeal shock wave lithotripsy. This is confirmed by 30 years of observation in the only treatment of kidney calculi by Alken launched in 1981 and continued by Jones et al. Before the era of endoscopic procedures (PCNL and URSL) effectively removed the only deposits in the kidney in open operations. Minimally invasive treatments are recommended for patients with localized deposits in the pelvicalyceal system or solitary kidney ureter. They are recognized as safe and effective treatment in a solitary kidney in particular in patients who have already been operated on.
We describe a case of minimally invasive endoscopic technique used in the treatment of a large calculus in the intestinal neobladder. The patient had the intestinal bladder created by means of the Vesica Ileale Padovana (VIP) method because of an invasive urothelial carcinoma. The use of the pneumatic lithotripter, inserted through the urethra into the intestinal neobladder, enabled crushing of the calculus and safe evacuation of the resulting small fragments. The endoscopic technique described enabled avoidance of a technically difficult surgical treatment and allowed for rapid return of the patient to complete health. In our opinion this is the best method of treatment.
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