Letter to the Editor - Management of Nephrolithiasis in Crossed Renal Ectopia

A 40-year-old male presented with vague lower abdominal pain of six months duration associated with recurrent dysuria. Urine microscopy showed 20-40 red cells and 30-40 pus cells per high power field. Urine culture showed E-coli. An X-ray of kidney, ureter and bladder area showed multiple radio opaque shadows lying in right lumbar region and over iliac bone area. Ultrasonsgraphy showed absence of left kidney and hydronephrotic right kidney with multiple renal stones in right renal fossa. An intravenous urogram showed crossed renal ectopia with multiple calculi and normal functioning upper moiety and poorly functioning lower moiety. He was taken up for cystoscopy and bilateral retrograde pyelography with drainage film and open pyelolithotomy. Cystoscopy showed normal capacity bladder with normally positioned ureteric orifices. A retrograde ureteropyelogram delineated normal calipe ureters. There was drainage of dye into bladder from both the moieties as seen under image intensifier. Kidneys were exposed by long lumbar incision and extended pyelolithotomy in upper moiety was carried out. Lower moiety required pyelotomy with two nephrotomies to clear the stones. Double J stents were left in both the moieties for 6 weeks. There were no intraoperative or postoperative complications. A check x-ray on second postoperative day showed complete clearance. Patient was asymptomatic without urinary tract infection at a follow up of 6 months.