Radical Cystectomy and Lymphadenectomy to Two Patients with Pelvic Kidney: Surgical Pitfalls and Considerations

Abstract

Our goal is to describe our experience in the difficulties encountered during radical cystectomy for muscle invasive bladder cancer in patients with contemporary pelvic kidney. Two patients with muscle invasive bladder cancer and contemporary pelvic kidney were subjected to radical cystectomy and extended lymphadenectomy with conversion to an ileal pouch. In both cases, lymphadenectomy was the first step after entering the true pelvis. In order to proceed to the cystoprostatectomy, careful dissection of the ectopic renal vessels and proper mobilization of the kidney were performed. In both cases, an ileal pouch was our choice. The pelvic kidney is the most common sight of renal ectopia. The etiology is the aborted ascent of the fetal kidney from its initial position in the pelvis. This is the first case series describing radical cystectomy for muscle invasive urothelial carcinoma of the bladder in patients with a pelvic kidney.

Bilateral Malrotation and a Congenital Pelvic Kidney with Varied Vasculature and Altered Hilar Anatomy

“…Gülsün et al, 2000 [ 10 ], reported a right pelvic kidney supplied by three arteries arising from bilateral common iliac arteries and from ipsilateral internal iliac artery. Adamakis et al, 2012 [ 3 ], discovered two cases of left pelvic kidney during surgical staging of bladder carcinoma. In both cases, the left renal veins drained into IVC; the renal artery was single arising from distal part of aorta and left internal iliac artery, respectively.…”

“…In both cases, the left renal veins drained into IVC; the renal artery was single arising from distal part of aorta and left internal iliac artery, respectively. Both studies presented a shorter length of ureter [ 3 ]. However the present case presented different features; that is, the arterial supply was from three sources, that is, aorta, common iliac, and inferior vesical artery.…”

“…The exact mechanism is unknown. The role of an inductive substance secreted by the kidney is invoked [ 3 ]. The second opinion says that the kidney undergoes a pseudoascension caused by the fast development of the caudal extremity of the fetus [ 8 , 11 , 12 ].…”

“…The absence or the incomplete cephalad migration and rotation of the metanephric tissue and the ureteric bud in the 8th week of gestation may explain all possibilities of pelvic, iliac, abdominal, contralateral, or crossed ectopic kidney. The commonest type of renal ectopia is pelvic kidney; incidence varies from 1/2100 to 1/3000 of autopsies [ 3 ]. The pelvic kidney may be mistaken for a pelvic tumour on clinical examination [ 4 ].…”

Laparoscopic Nephrectomy in Patients with Congenital Kidney Anomalies: Single-Centre Results

“…The most common ectopy type is pelvic kidney, and its incidence rate varies between 1/2100 and 1/3000. 3 There is a tendency for kidney-stone formation and hydronephrosis in ectopic kidneys. 4 Congenital kidney-anomaly patients' kidneys may lose function due to urinary-system anomalies, and nephrectomy could be needed.…”