Crossed Fused Ectopia of Kidney – An Account of Tertiary Healthcare Center Experience

Abstract

Background: Crossed renal ectopia with fusion is the abnormal migration of the kidney to the opposite side of the insertion of the ureter to the bladder. It is the second most common congenital anomaly of the kidney and urinary tract preceded by horseshoe kidney. The following article serves to highlight the anomaly in a conglomeration of 17 unique cases, managed in our tertiary care centre over a period of 5 years. Materials and Methods: This is a descriptive study analysing the demographic features and the management of seventeen patients diagnosed with crossed renal ectopia with fusion during the period January 2012 to January 2017. Radiological modalities of investigation were modified as per the anomaly. The management plan was devised keeping in mind, the essence of preserving the functional unit. Results: Of the seventeen cases, nine patients were symptomatic and eight were asymptomatic. The most recurring crossed renal ectopia with fusion was L- shaped (n=6), disc shaped (n=6) sigmoid shaped (n=2), inferior (n=1), cake shaped (n=1) and superior ectopia (n=1). Left to right ectopia (n=9) was more common than right to left (n=8). Three patients had a solitary crossed ectopia. Out of nine symptomatic patients, six patients underwent surgical procedures, the remaining three were treated conservatively and advised regular biannual follow-up with imaging. Conclusion: The management of crossed renal ectopia with fusion is individualised according to the underlying urological anomaly and its sequelae. Importance is given to preserve the renal function whenever possible. Reconstructive surgeries like pyeloplasty, ureteric reimplantation, boari flap can salvage some function in these units.