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Isthmus undivided bilateral nephrectomy in a patient with polycystic horseshoe kidney.

Yao XL, Jin BY, Wang YM, Wang YM - Chin. Med. J. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, The First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang 310003, China.

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Horseshoe kidney is a type of renal fusion by the lower poles anomaly during embryogenesis... She complained of recurrent fever and hematuria and was admitted to hospital for bilateral nephrectomy in controlling severe kidney infection and preparation for renal transplantation... She felt recurrent attacks of bilateral loin pains without rigors and vomiting and medications did not improve the situation... Horseshoe kidney is the most common type of renal fusion with the incidence of 1 in 400–1 in 800... Great attention was paid in our procedures to prevent heavy bleeding when isolating the isthmus from the inferior vena cava abdominal aorta lying under the isthmus... There are two advantages of isthmus undivided bilateral nephrectomy of a polycystic horseshoe kidney versus cutting isthmus... On one hand, the isthmus is usually thick with rich blood supply, keeping the isthmus intact could dramatically reduce the risk of bleeding and save operation time... On the other hand, the cysts of the kidney are often accompanied by infection... Our approach prevented the infected fluid entering into the peritoneal cavity, which could cause severe infection after operation... Additionally, more CO2 would be absorbed in laparoscopic procedure that could increase the risk of acidosis especially for the patient with end stage renal failure, maybe our method was better in this special situation.

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Sample of the polycystic horseshoe kidney with intact isthmus removed from the patient.
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Figure 2: Sample of the polycystic horseshoe kidney with intact isthmus removed from the patient.

Mentions: Bilateral nephrectomy was performed when the body condition was suitable. The patient was placed in the supine position with her right arm extended. A 20 cm long midline abdominal incision was used to enter the peritoneal cavity. Move the colon to the left side for exposing the right kidney. The volume of the right kidney was substantially enlarged, and the surface was full of varicolored cysts. After locating the inferior vena cava, the renal hilum was identified to the right side of inferior vena cava. The renal artery and vein were stapled and transected separately. The right kidney was isolated from the upper pole with preservation of the adrenal gland. Right ureter was located and cut with clips to free the inferior pole including the isthmus. Same procedures were done to the left kidney until both kidneys were entirely isolated without dividing the isthmus. The polycystic horseshoe kidney was completely removed out of the cavity as shown in Figure 2. The length and width of the sample were 20.3 cm and 14.2 cm respectively, and the weight was 9.4 kg.


Isthmus undivided bilateral nephrectomy in a patient with polycystic horseshoe kidney.

Yao XL, Jin BY, Wang YM, Wang YM - Chin. Med. J. (2015)

Sample of the polycystic horseshoe kidney with intact isthmus removed from the patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834786&req=5

Figure 2: Sample of the polycystic horseshoe kidney with intact isthmus removed from the patient.
Mentions: Bilateral nephrectomy was performed when the body condition was suitable. The patient was placed in the supine position with her right arm extended. A 20 cm long midline abdominal incision was used to enter the peritoneal cavity. Move the colon to the left side for exposing the right kidney. The volume of the right kidney was substantially enlarged, and the surface was full of varicolored cysts. After locating the inferior vena cava, the renal hilum was identified to the right side of inferior vena cava. The renal artery and vein were stapled and transected separately. The right kidney was isolated from the upper pole with preservation of the adrenal gland. Right ureter was located and cut with clips to free the inferior pole including the isthmus. Same procedures were done to the left kidney until both kidneys were entirely isolated without dividing the isthmus. The polycystic horseshoe kidney was completely removed out of the cavity as shown in Figure 2. The length and width of the sample were 20.3 cm and 14.2 cm respectively, and the weight was 9.4 kg.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, The First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang 310003, China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Horseshoe kidney is a type of renal fusion by the lower poles anomaly during embryogenesis... She complained of recurrent fever and hematuria and was admitted to hospital for bilateral nephrectomy in controlling severe kidney infection and preparation for renal transplantation... She felt recurrent attacks of bilateral loin pains without rigors and vomiting and medications did not improve the situation... Horseshoe kidney is the most common type of renal fusion with the incidence of 1 in 400–1 in 800... Great attention was paid in our procedures to prevent heavy bleeding when isolating the isthmus from the inferior vena cava abdominal aorta lying under the isthmus... There are two advantages of isthmus undivided bilateral nephrectomy of a polycystic horseshoe kidney versus cutting isthmus... On one hand, the isthmus is usually thick with rich blood supply, keeping the isthmus intact could dramatically reduce the risk of bleeding and save operation time... On the other hand, the cysts of the kidney are often accompanied by infection... Our approach prevented the infected fluid entering into the peritoneal cavity, which could cause severe infection after operation... Additionally, more CO2 would be absorbed in laparoscopic procedure that could increase the risk of acidosis especially for the patient with end stage renal failure, maybe our method was better in this special situation.

Show MeSH
Related in: MedlinePlus