Fused ureters in patient with horseshoe kidney and aortic abdominal aneurysm

Abstract

Horseshoe kidney (HSK) is a very common developmental abnormality in the kidney. They are associated with abnormalities like multiple renal arteries, abnormal position of the ureter in the renal pelvis and highly placed ureteropelvic junction. These can result in urological complications. However, the ureters run their separate course and empty individually into the urinary bladder. Surprisingly, anatomical anomalies do occur and can lead to unexpected findings on investigation or surgical treatment. Such anomalies can present diagnostic and management challenges to unsuspecting clinicians. This report deals with one of such anomalies that seem not to have been reported before in the literature. This case is a rare finding of fused ureters over the renal isthmus in a patient with HSK who also has aortic abdominal aneurysm (AAA). Simultaneous occurrences of HSK and AAA have been reported severally in the past, and the authors are paying attention on the ureteral anomaly.

Incidence and characteristics of kidney stones in patients with horseshoe kidney: A systematic review and meta-analysis

“…Horseshoe kidney (HSK) is the most common abnormality renal fusion anomaly,[ 13 ] estimated to be 1/400–1600 births with the prevalence of 0.25% among the general population. [ 14 15 16 ] Its developmental abnormalities include the fusion of the lower poles, resulting in abnormal position of the ureter in the renal pelvis, and highly placed ureteropelvic junction. [ 17 ] Impaired drainage of the collecting system and associating ureteropelvic obstruction may predispose the patient to kidney stones.…”

Management and therapeutic options for abdominal aortic aneurysm coexistent with horseshoe kidney

“…In its presence, the ureters are usually positioned more medially than normal, crossing the renal symphysis anteriorly. 27 Obidike et al 28 presented a unique case with fusion of both ureters anterior to the renal isthmus. During aortic reconstruction, caution is advised to avoid injury of the ureters because urinary leak is a life-threatening complication after implantation of a prosthetic graft.…”