Spectrum of Ectopic Pelvic Kidney in Children: A Ten-year Experience.

Introduction: Many patients with ectopic kidneys remain often undiagnosed or asymptomatic throughout life. Ectopic pelvic kidneys present a large spectrum of presentation and symptoms from renal dysplasia to a severe obstruction. One of the most common problem is the UPJ obstruction with stones formation. We present here our experience of pelvic kidney in children, the clinical presentation and the surgical procedures performed Material and Methods: A total of 17 children, aged from 6 months to 17 years, (14m;3f) were referred to our Institution between January 2004 to June 2014 for pelvic kidney. There were 5 (29.41%) left and 12 (70.5%) right Kidneys. 1. 9 patients presented with moderate to severe UPJ obstruction (three cases with 10 to 20mm pelvic stones) with normal/moderately-reduced ≥25% relative function at MAG3 radionuclide scan of these patients, 5 with clear symptoms of UPJ obstruction underwent a laparoscopic dismembered Anderson –Hynes pyeloplasty. The remaining 4, presented symptomatic intermittent hydronephrosis with colic abdominal pain. These patients underwent pelvis derotation through a minimally invasive transposition of the UPJ. 2. 5 patients presented non-functioning kidneys, in 2 cases associated to hypertension, and underwent laparoscopic nephrectomy. 3. 2 patients presented asymptomatic pelvic kidney. 4. 1 patient presented 3rd G. VUR on the ipsilateral pelvic kidney. The associate pathology was 1 midshaft hypospadias, 2 criptorchidism , 1 mild mitral insufficiency. The evaluation of each patient involved their personal and family medical history, ultrasound examination, VCUG, MAG3 renal scan and MRI in selected cases. Results: After a mean follow-up of 6.9 yrs the majority of the patients are well and none present hypertension. Symptoms resolved in 13 out of 15 surgical patients. 2 patients needed the positioning of a double J stent from 3 to 8 months after pyeloplasty that was removed from 6 to 12 weeks after the procedure Conclusion: Pelvic kidneys present a large spectrum of symptoms. UPJ obstruction with/without stones, intermittent hydronephrosis, recurrent abdominal pain, UTI is the most frequent symptoms. The majority of our patients needed surgical procedures. In four cases there were associated pathologies as hypospadias, cryptorchidism, and mild mitral insufficiency. Laparoscopic approach seems a useful tool for the treatment of these kidneys. Pelvis derotation can be an easy and effective procedure in moderate, intermittent obstruction.