Challenging retrograde intrarenal surgery in a pelvic ectopic kidney- an institutional case report and review of literature


  • Kiron Krishnaprasad Department of Urology, GTDMCH, Vandanam, Alappuzha, Kerala, India
  • Darsan Sadasivan Department of Urology, GTDMCH, Vandanam, Alappuzha, Kerala, India
  • Tony Thomas John Department of Urology, GTDMCH, Vandanam, Alappuzha, Kerala, India
  • M. Nazar Department of Urology, GTDMCH, Vandanam, Alappuzha, Kerala, India



Case report, Flexiscopy, Holmium laser, Pelvic ectopic, Stone


Retrograde intrarenal surgery (RIRS) has been increasingly used as an effective treatment modality for treatment of stones in anatomically abnormal kidneys. A challenging RIRS in a 27-year-old man, done for a 1 cm calculus in a pelvic ectopic kidney is being presented here in order to highlight the technical difficulties encountered, safety and outcome of RIRS for pelvic ectopic kidneys. A 27-year-old man presented with the chief complaints of left sided flank pain of one year duration. He was discovered to have a left pelvic ectopic kidney 7 years back and later discovered to have a calculus within it 1 year back. He had a history of an attempted rigid ureteroscopy 2 months back at another hospital where they were unable to reach the stone, so they placed a Double J stent over a guidewire. The patient was worked up and taken up for surgery at our institution. Intraoperatively there was a kink at the PUJ, below which the access sheath was placed under C arm guidance and with the flexiscope, the kink was negotiated to reach the stone. Holmium laser was used to disintegrate the stone and DJ stent was placed. Post operatively patient was stable and discharged on day 2. RIRS is a safe and effective modality for the treatment of calculi in pelvic kidneys as seen, technical difficulties like kinks can be overcome by flexiscopy.


Cinman NM, Okeke Z, Smith AD. Pelvic Kidney: Associated Diseases and Treatment. J Endourol. 2007;21(8):836-42.

Niknejad M, Skandhan A. Ectopic kidney. 2013. Available at: Accessed on 2022 Jan 22.

Ectopic Kidney | NIDDK. Available at: Accessed on 2022 Jan 22.

Huffman JL, Bagley DH, Lyon ES. Extending Cystoscopic Techniques Into the Ureter and Renal Pelvis: Experience With Ureteroscopy and Pyeloscopy. JAMA. 1983;250(15):2002-5.

Kılıç Ö, Akand M, van Cleynenbreugel B. Retrograde intrarenal surgery for renal stones-Part 2. Turkish journal of urology. 2017;43(3):252-60.

Sarı S, Çakıcı MÇ, Aykaç A, Baran Ö, Kartal İG, Özok HU et al. Kidney Stone Treatment in the Anomalous Kidney with Retrograde Intrarenal Surgery: A Matched Pair Analysis. J Urol Surg. 2020;7(3):166-71.

Di Franco CA, Burrello M, Guzzardi F, Intagliata E, Oxenius I, Galvagno L et al. Management of a kidney stone in ectopic pelvic kidney with Extracorporeal Shockwave Litothripsy: Description of a case and revision of literature. 2020;92(2):109-11.

Demirkesen O, Yaycioglu O, Onal B, Kalkan M, Tansu N, Yalcin V et al. Extracorporeal shockwave lithotripsy for stones in abnormal urinary tracts: analysis of results and comparison with normal urinary tracts. J endourol. 2001;15(7):681-5.

Talic RF. Extracorporeal shock-wave lithotripsy monotherapy in renal pelvic ectopia. Urology. 1996;48(6):857-61.

Gupta NP, Mishra S, Seth A, Anand A. Percutaneous nephrolithotomy in abnormal kidneys: single-center experience. Urology. 2009;73(4):710-4.

Holman E, Tóth C. Laparoscopically assisted percutaneous transperitoneal nephrolithotomy in pelvic dystopic kidneys: experience in 15 successful cases. J laparoendoscopic adv surg tech Part A. 1998;8(6):431-5.

Wu J, Shen J. The safety and efficacy of mini-percutaneous nephrolithotomy vs. retrograde intrarenal surgery for treatment of renal lithiasis in pelvic ectopic kidney: an exploratory pilot study. Translational Androl Urol. 2021;10(4):1734.

Bozkurt OF, Tepeler A, Sninsky B, Ozyuvali E, Ziypak T, Atis G et al. Flexible Ureterorenoscopy for the Treatment of Kidney Stone Within Pelvic Ectopic Kidney. Urology. 2014;84(6):1285-9.

Lavan L, Herrmann T, Netsch C, Becker B, Somani BK. Outcomes of ureteroscopy for stone disease in anomalous kidneys: a systematic review. World J Urol. 2020;38(5):1135-46.






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