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A 27-year-old man was referred to our hospital with right-sided back pain and renal dysfunction. Computed tomography revealed a right-sided horseshoe kidney with hydronephrosis and a thin renal cortex. Diuretic renography revealed a nonfunctioning right kidney. We diagnosed the patient with a symptomatic nonfunctioning right kidney and performed laparoscopic right heminephrectomy. His right-sided back pain reduced postoperatively ; however, he developed retrograde ejaculation, which was attributable to intraoperative injury to the superior hypogastric nerve plexus. We treated the patient with amoxapine (an antidepressant), which led to improvement in retrograde ejaculation., PDFのタイトル: 「腹腔鏡鏡下」は誤植, 正しくは「腹腔鏡下」

A 76-year-old man was introduced to our department with a right kidney stone. On the basis of further examination, he was diagnosed with a 23 mm right kidney stone accompanied with a horseshoe kidney. Retrograde pyelography and diuretic renogram revealed a non-obstructed right ureteropelvic junction. Finally, we chose laparoscopic pyelolithotomy via peritoneal approach because the stone was large and accompanied with a horseshoe kidney. The surgery took 165 minutes and the estimated blood loss was 25 ml. There were no minor or major complications. Because horseshoe kidney has anatomical abnormalities, it seems to be necessary to consider a different treatment strategy from that of an upper urinary tract stone in a healthy kidney. We assume that laparoscopic pyelolithotomy is an effective and safe procedure for renal pelvic stones in the case of a horseshoe kidney.

A 62-year-old man was suffering from asymptomatic gross hematuria. Abdominal computed tomography demonstrated a horseshoe kidney and renal pelvic tumor in the left kidney. Open nephrectomy with division of the isthmus was performed. The pathological diagnosis was urothelial carcinoma, grade 2＞ grade 3, pT3. He is free of disease at 13 months after operation. To our knowledge, in Japan, this is the 33th case of renal pelvic tumor in a horseshoe kidney.

A 66-year-oldwoman hada 22 mm right kidney stone accompaniedwith a horseshoe kidney. The size of this stone had been increasing gradually from 7 mm to 22 mm during the past 5 years. Although apparent pelviuretic junction stenosis couldnot be identifiedby intravenous urography, external pelvis was dilated in both kidneys. Complete excretion of fragmented stones by extracorporeal shockwave lithotripsy seemedto be difficult because impairedurinary passage from the renal pelvis to the ureter was suspected. Percutaneous nephrolithotomy was also difficult due to malrotation of the pelvic-caliceal system and possible interposition of bowel loops between kidney and abdominal wall. Therefore, we chose laparoscopic pyelolithotomy. This procedure made it possible to remove the stone completely with minimum invasiveness. We assume that laparoscopic pyelolithotomy is a safe andeffective approach for renal pelvic stone in case of horseshoe kidney.

A 30-year-old female was referred to our hospital complaining of left flank pain. She was diagnosed with a giant hydronephrosis in a horseshoe kidney. We performed a retroperitoneoscopic nephrectomy on the non-functioning moiety of the horseshoe kidney. After the placement of a ureteral catheter, she underwent a retroperitoneal nephrectomy. The feeding vessels consisted of four arteries and four veins. The thin isthmus of the horseshoe kidney was divided using scissors, without the need for electrocautery, and hemostasis was achieved using monopolar shears. Laparoscopic nephrectomy on a horseshoe kidney is a difficult surgery given the aberrant vessels and isthmus, so it tends to be avoided for reasons of safety. However, if appropriate preoperative imaging is carried out and the procedure is conducted in a careful manner, it can be made a safe and minimally invasive operation.

Carcinoid tumor of the kidney is an extremely rare neoplasm. We report a case of primary carcinoid tumor arising from a horseshoe kidney in a 31-year-old man. An abdominal bulky mass was found at a local hospital and he was referred to our hospital for examination and treatment. From the results of computed tomography, magnetic resonance imaging and angiography, we suspected renal tumor arising from a horseshoe kidney and performed left partial nephrectomy with isthmectomy. Pathological findings of hematoxylin eosin staining revealed tumor cells proliferating in a cord-like and ribbon-like structure and the tumor cells stained strongly for chromogranin A, grimelius and neuron specific enolase. According to these findings, we diagnosed carcinoid tumor arising from a horseshoe kidney.

71歳男性.交通事故で受傷し, 救急外来に搬送された.受診時のCTで, 後腹膜への出血を伴う馬蹄腎の狭部離断と診断した.安静, 止血剤及び抗生剤投与にて経過観察したところ, 受傷後3時間後より嘔吐, 腹部膨満を訴え, 出血性ショックとなったため, 緊急血管造影を施行した.大動脈造影及び選択的右腎動脈造影により, 右腎動静脈奇形及びその破裂と診断し, スチールコイルを用いて右腎動脈下極分枝の塞栓術を施行した.塞栓術後, 全身状態は安定していたが, 翌日になって気管支肺炎および急性呼吸促迫症候群が出現した.呼吸管理を行うとともに抗生剤投与, ステロイドパルス療法を施行したところ改善した.受傷後22日目のCTでは血腫は縮小しており, 25日目に退院した.4ヵ月目の血管造影でも腎動静脈奇形の再開通を認めなかった, A case report of a patient with renal arteriovenous malformation associated with horseshoe kidney detected by hemorrhage due to injury. A 71-year-old man was injured in a traffic accident and conveyed to our hospital. The computed tomographic scan showed renal injury of the horseshoe kidney with retroperitonial hemorrhage. We treated him conservatively, but he complained of abdominal fullness and went into hemorrhagic shock. So, we performed arterial angiography. It showed a right renal arteriovenous malformation from which leakage of contrast medium was detected. Hemostasis was possible by embolization of the abnormal artery. He has not had any recurrence of renal arteriovenous malformation. To our knowledge, this case is the third report of renal arteriovenous malformation associated with horseshoe kidney in Japan.

金沢大学医薬保健研究域医学系, We describe the case of an 83-year-old woman who underwent surgical repair for abdominal aortic aneurysm with horseshoe kidney. Preoperative computed tomography (CT) scans showed the presence of not only the principal bilateral renal arteries but 2 accessory renal arteries originating from the right common iliac artery. The left accessory renal artery had 2 branches supplying each of the lower poles of the kidneys. We performed open surgery for artificial graft replacement by dividing the isthmus. The isthmus was formed of fibrous connective tissue therefore we dissected the isthmus sharply and sutured edges. A urinary fistula was absent. Since supply to the right renal lower pole via the left accessory artery was negligible, the artery was ligated. We performed this procedure safely and achieved a successful outcome., 馬蹄腎を合併した腹部大動脈瘤の症例では，腎峡部および異所性血管の処理が重要となる．症例は83歳，女性．馬蹄腎を合併した腹部大動脈瘤を指摘されていた．術前CT所見では左右腎主動脈のほかに，右総腸骨動脈より2本の腎副動脈を認めた．さらに，左腎副動脈は2本に分岐し，それぞれ左右腎下極に流入していた．手術では，腎峡部を離断し人工血管で置換した．腎峡部は線維性結合織で構成されており，離断し断端形成した．また，左腎副動脈右腎下極枝は温存困難な場所にあり，細く結紮切離した．尿漏出などの異常は認めなかった．腎峡部，腎副動脈の1本を処理したが，主要腎副動脈を温存し，人工血管置換術を安全，確実に行い良好な結果を得た．

A 59-year-old man visited another hospital with a chief complaint of malaise. Radiological examinations revealed a renal cell carcinoma associated with horseshoe kidney. He was referred to our hospital. The patient was successfully treated with open partial nephrectomy following isthmus division. Histological findings exhibited grade 2, pT1a, clear cell type, renal cell carcinoma. He is free of disease at twelve monthsafter the operation.

48歳男。患者は右腎腫瘤を主訴とした。KUBでネフログラムの長軸が下方で交叉している馬蹄鉄腎に特徴的な所見が認められた。腹部エコーでは右腎下極に約4cm大のSOLを認め, ドップラーエコーでは血流豊富であり, 内部に隔壁がみられた。更にMDCTでは右腎動脈は4本認め, どれも大動脈から直接分岐していた。だが, 峡部への流入動脈ははっきりせず, 右腎静脈は2本であった。以上より, 本症例は馬蹄鉄腎に合併した右腎細胞癌と診断され, 経腹的に峡部離断術, 右半腎摘除術が施行された。その際, 峡部離断にはLigaSureを用い, ほぼ無血的に処理でき, 複数の腎血管の処理が行われた。病理組織学的所見ではclear cell carcinoma, pT3a, INFα, v-, G1>G2であり, 術後約7ヵ月現在, 再発および転移は認められていない。, We report a case of renal cell carcinoma in a horseshoe kidney in a 48-year-old man. A medical checkup revealed a renal tumor in the right kidney. Computed tomographic scan (CT) showed a renal tumor measuring about 4 cm in diameter on the right side of a horseshoe kidney. Right heminephrectomy was performed for renal cell carcinoma. Pathologic examination revealed renal cell carcinoma, clear cell subtype, G1>G2, INF alpha, pT3a, V (-). In addition to our case, we review 66 cases of renal cell carcinoma occurring in a horseshoe kidney which have been reported in Japanese publications; our case is the 67th.

52歳女性。患者は乳癌術後観察中のCTにて左腎上極の腫瘤が指摘され, 著者らの施設ヘ紹介となった。臨床検査では異常所見は認められず, 腹部CT・MRIにより馬蹄鉄腎に発生した左腎細胞癌が疑われた。腎部分切除術を行なった結果, 病理組織学的に腫瘍は腎血管筋脂肪腫と診断され, 術後は経過良好であった。, The patient was 52 years old. She had undergone a breast cancer operation 4 years before this visit. On computed tomography (CT), a left renal tumor in a horseshoe kidney was incidentally pointed out. CT scan showed a 1.8-cm enhanced tumor in the upper pole of the left kidney. It was hyperechoic on ultrasonography. Since renal cell carcinoma could not be excluded preoperatively, left partial nephrectomy was performed. Pathological diagnosis was a renal angiomyolipoma. The incidence of horseshoe kidney is 1 in 400. The occurrence of hydronephrosis, infection and calculous disease is not uncommon. However, a case of angiomyolipoma simultaneously with a horseshoe kidney is very rare, this being the 7th case in the literature.

A 71-year-old woman with loss of appetite was referred to our hospital. Imaging diagnosis revealed a large, cystically dilated left kidney with a solid tumor inside the cavity and right hydronephrosis. A chest X-ray revealed multiple metastatic lesions. A horseshoe kidney was found intraoperatively and left nephroureterectomy with partial cystectomy was performed. Histological diagnosis was poorly differentiated transitional cell carcinoma. She died of progressive pulmonary metastases 2 weeks after operation. This is the 19th case of a renal pelvic tumor associated with a horseshoe kidney reported in the Japanese literature. The diagnosis was confounded by the extreme dilation and deformity of the hydronephrotic kidney.

We herein report a case of renal cell carcinoma in a horseshoe kidney with an abdominal aortic aneurysm in a 69-year-old man. Radiological examinations showed a left renal tumor, horseshoe kidney and abdominal aortic aneurysm. We performed a left radical nephrectomy with the division of the isthmus and artificial graft through an abdominal transperitoneal approach. Histological findings revealed clear cell type renal cell carcinoma without invasion of the capsule or renal pelvis. Only 31 cases of renal cell carcinoma in a horseshoe kidney have been reported in Japan, and our case is the 32nd. No case with abdominal aortic aneurysm has been reported previously. We assume that abdominal aortic aneurysm was associated with renal cell carcinoma by chance in the horseshoe kidney in this case. The arterial and venous supplies vary from case to case. We emphasize that arteriography and venography are very important preoperative procedures.

At Osaka City University, 1, 987 patients with urolithiasis have been treated by extra-corporeal shockwave lithotripsy (ESWL) during a four-year period. We treated 5 patients with horseshoe kidney and the obtained results were analyzed retrospectively. Three of these patients, who had a solitary stone could successfully be treated by ESWL as monotherapy. One who had multiple stones required transurethral lithotripsy after ESWL due to stone-street. The remaining 1 patient who had undergone heminephrectomy developed perirenal hematoma after ESWL, which spontaneously disappeared without any specific treatment. We discuss the special care related to the use of ESWL in the horseshoe kidney.

症例は79歳女で, 右無機能腎を伴った馬蹄鉄腎に発生した左尿管膀胱腫瘍例である.組織学的には移行上皮癌ではあるが, 尿管, 膀胱に生じた腫瘍であった.発生については, 家族歴では多くの癌患者を有し, 既往歴でも3重複癌の状態にあった.本症例は当院外科より異時性多発重複癌として報告されており, 今回の尿管膀胱移行上皮癌の発生で4重複癌となる.いずれの癌も偶発癌でなく, 臨床的に癌として診断され, 手術療法を受けている点が特徴的である.これまで2回尿管部分切除を行い, 腎機能を保存し, 尿路変向もせずQOLの保持目的は果されているとみられた, A 79-year-old woman was admitted with recurrent ureteral and bladder cancers. She had a horseshoe kidney with a non-functioning right renal unit. Fifteen months earlier, multiple urothelial tumors had first developed in the left upper ureter and bladder. Transurethral resection of bladder tumor (TUR-Bt) and partial ureterectomy (2 cm) had been performed. Presently, the recurrent tumors were located at the left lower ureter and bladder. Considering the high age of the patient, TUR-Bt and partial ureterectomy (5 cm) were performed. Besides urothelial cancers, she had been operated for carcinomas of the colon, uterus and stomach. Kidney-sparing therapy has successfully maintained her quality of life.

左腎臓腫瘤精査を目的とした69歳男で, CT及びMRI上, 馬蹄腎の左側に腎静脈血栓随伴異構造性腫瘤を認めた.大動脈造影では左腎に血管過多腫瘤及び大動脈から分岐し峡部に走る異所性動脈が認められた.峡部で切離し左腎摘除を行った.グレード2, ステージT3bの腎細胞癌であった.腫瘍はないが, 術後5ヵ月に脳内出血で死亡した, A 69-year-old man presented for further examination for left renal mass. Computed tomography and magnetic resonance imaging revealed a heterogenous mass on the left side of a horseshoe kidney accompanied with renal vein thrombus. Aortography showed a hypervascular mass in the left kidney and aberrant arteries to the isthmus originating from the aorta. A left nephrectomy with the division of the isthmus was performed through an abdominal transperitoneal approach. Histological evaluation revealed grade 2, stage T3b, renal cell carcinoma. The patient was free of tumor, but died of intracerebral hemorrhage 5 months after the operation.

We report 2 patients with renal cell carcinoma in a horseshoe kidney. A renal tumor was diagnosed during evaluation of right humeral metastatic cancer of unknown origin in case 1 (64-year-old male) and gross hematuria in case 2 (54-year-old male). Both patients underwent radical nephrectomy with division of isthmus and retroperitoneal lymph node dissection. The tumors were staged pathologically as pT2bpN0pV0pM1(oss) and pT3pN0pV1bM0, respectively. Only 27 cases of renal cell carcinoma developed in a horseshoe kidney, including the present two cases, have been reported in the Japanese literature. The blood supply to the horseshoe kidney and its evaluation by preoperative angiography were discussed.

65歳男, 馬蹄鉄腎に合併した腎細胞癌としては本邦第19例目である.馬蹄鉄腎に合併する腫瘍は正常腎にくらべ腎細胞癌が相対的に少なく, 腎芽細胞腫, 腎盂腫瘍の相対頻度が高いという注目すべき点がある, A 65-year-old man with pyuria visited our hospital. Physical examination had revealed a mass in the left upper quadrant of the abdomen. Intravenous pyelogram, ultrasonogram, computerized tomography and selective renal arteriogram suggested a hypervascular renal cell carcinoma on the left side of the horseshoe kidney. A left radical nephrectomy with division of the isthmus was performed. The pathological diagnosis indicated renal cell carcinoma consisting of clear cell type without invasion of the capsule or renal pelvis. Treatment with alpha-interferon was started and has continued for six months with no evidence of recurrence. Only 35 cases of horseshoe kidney with a renal tumor have been reported in the Japanese literature. Among them, adenocarcinoma was present in 54.3% of the cases, renal pelvic tumor in 17.1%, and nephroblastoma in 14.3%. While adenocarcinoma in horseshoe kidney is seen less often than normal kidney, there is an increased incidence of both renal pelvic tumor and nephroblastoma.

We report a 68-year-old man with renal cell carcinoma in a horseshoe kidney. Abdominal computed tomography revealed a left renal tumor in a horseshoe kidney, and we carried out left radical nephrectomy. Histopathological diagnosis was renal cell carcinoma. Only 19 cases of renal cell carcinoma in a horseshoe kidney have been reported in Japan, and our case was the 20th.

A case of bilateral asynchronous ureteral tumors in a 58-year-old man associated with a horseshoe kidney was reported. First, left heminephrectomy with total left ureterectomy had been performed because of the left ureteral carcinoma. Three years and 8 months later, he was admitted and an emergency right nephrostomy was made on account of false anuria. Then, right ureterectomy with total cystectomy was the choice of treatment against the ureteral tumor on the right side. This case of bilateral ureteral tumors associated with a horseshoe kidney appears to be the first one reported in the Japanese literature.

A very rare case of renal cell carcinoma of the horseshoe kidney that produced AFP and caused hypercalcemia is reported. The relationship between this renal cell carcinoma and hypercalcemia was obvious, but the mechanism of hypercalcemia was not revealed. The presence of AFP in cancer cells was demonstrated using the "ABC" method.

A 4-month old baby was seen in August, 1982 because of abdominal distension. The findings of the physical examination were normal except for a man's fist sized mass in the left upper abdomen. IVP revealed left nonvisualizing kidney. CT scans revealed a large mass in the left abdomen with low density contents and renal scintigraphy revealed a horseshoe kidney. The tentative diagnosis was horseshoe kidney associated with hydronephrosis due to ureteropelvic junction obstruction. Left pyeloplasty was performed in September 1982 and postoperative X-ray examinations revealed left ureterovesical junction obstruction. Left ureteroneocystostomy was performed in October, 1982 and postoperative course was uneventful. Horseshoe kidney in infants is rare in the Japanese literature and our case is quite unique in that horseshoe kidney is associated with ureteropelvic junction and ureterovesical junction obstruction.

A case of combined anomalies of the urinary tract, horseshoe kidney, retrocaval ureter and pelviureteric stenosis, is presented. Routine urological examination of a three-year-old girl who complained of recurrent cystitis, showed horseshoe kidney and right hydronephrosis. Surgical exploration revealed the retrocaval ureter, and the isthmus of the horseshoe kidney lying between the aorta and the inferior vena cava. The pelviureteric junction itself was also stenotic and compressed from behind by the aberrant vessels. In addition to the dismembered pyeloplasty in front of the vena cava, isthmotomy was performed. The literatures on such combined anomalies were reviewed.

A case of renal call carcinoma associated with horseshoe kidney is reported. The patient was a 59-year-old woman complaining of right flank mass. Radiological examination showed right renal tumor and horseshoe kidney, and right nephrectomy was performed. Histological examination showed it to be clear cell type renal cell carcinoma. Only 17 cases of horseshoe kidney with renal cell carcinoma have been reported in Japan. We report the 18th case with a review of the literature.

A case of renal angiomyolipoma originating from polycystic kidney with horseshoe kidney is reported. A 32-year-old woman visited our hospital with the complaint of proteinuria. with computerized tomographic scan and further examinations the patient was diagnosed as having renal angiomyolipoma with tuberous sclerosis. The tumor originated from a polycystic horseshoe kidney. Three weeks later, she complained of right flank pain and was diagnosed with spontaneous rupture of the angiomyolipoma. Right heminephrectomy was performed and histological examination confirmed the preoperative diagnosis. Some discussion is made on the characteristics and treatment of renal angiomyolipoma, and the statistics on renal diseases with tuberous sclerosis in Japan are presented.