A case report on pyelovesicostomy of PUJO of pelvic crossed fused renal ectopia with single ureter.

Introduction: A pyelovesicostomy is a rare procedure that offers an alternative to difficult pyeloplasty or failed pyeloplasty in the case of PUJO of pelvic renal ectopia. In this case report, we utilized pyelovesicostomy for a dilated renal pelvis of a crossed fused ectopic pelvic kidney with a single ureter.

Case Presentation: This is a 19-year-old male patient who received a diagnosis of pelvic ectopic kidney disease of 4 years duration. He was on a periodic DJ-stent exchange every 3 months at a different hospital. Upon presentation, the patient complains of pain in the right lower quadrant and a decrease in urine output. On physical examination, a palpable mass is detected in the right lower quadrant. The laboratory reveals an elevated creatinine level of 2.3 mg/dl. He was admitted with a diagnosis of acute kidney injury and a crossed fused ectopic pelvic kidney with Pelvic-Ureteric Junction Obstruction and a migrated Double-J stent. Initially, a semi-rigid ureteroscope guided the migrated DJ-stent, which was successfully removed and a new one was inserted. Later, an open surgery with a pyelovesicostomy was performed. Subsequently, the patient improved and was discharged.

Discussion: Pyelovesicostomy is an ideal treatment option for pelvic ureteral junction obstruction in congenital pelvic kidneys. The pyelovesicostomy should not be prone to strictures at the anastomotic site as long as it makes wide anastomosis, and the free reflux that results from the surgery shouldn't impair renal function.

Conclusion: Pyelovesicostomy is feasible, safe, and a potential treatment option for congenital-ectopic pelvic kidney with ureteric obstruction.