[TP-043]
Flexible Ureterolithotripsy Experience In Triple System (Supernumerary) Horseshoe Kidney Patient
Sinan Levent Kirecçi, Musab İlgi̇, Sedat Çakmak, Mais Allahverdiyev, Cemil KutsalTriple system kidneys are the rare anomaly of the urinary system, so due to the rarity of the anomaly that 's hard to face in the literature, and prevalence of it is unknown. We present a rare complex renal anomaly case, A 49 years male presented to urology department of our hospital with bilateral flank pain. It has been started for two weeks, and he suffered from visible hematuria without clot. Ultrasonographic examination of the patient revealed triple kidney with horseshoe anomaly. For further consideration, we proceed with CT urography which demonstrated the triple system and left ureteropelvıc junction calculı and right side kidney Stones, and then we decided to operate with making a flexible ureteroscopy. After approval of the anaesthesia, we used ( Karl Storz x2 flexible ureteroscopy, Ureteral Access Sheath (9.5f ), the 3f hydrophilic guidewire. Before the retrograde intrarenal surgery, we onset the procedure with the semirigid ureteroscopy and, left side ureter stone to fall to the bladder, however after the put the Access sheath we didn't find the calculi. Contrat fluid injects to ureter at that time, appeared the branching part of the ureter which way to the third kidney. When we push forward to the device, we found the stone the lower part of the third kidney and fragmented by the holmium YAG laser and 4.8f 26 cm pigtail stent was inserted. First-month control with direct bladder ureter roentgenograms that was stone free. Horseshoe renal anomaly presented to urology departments with various symptoms but, supernumerary (triple system) type is so rare. And these abnormalities predispose to the kidney stones.And preoperative imaginations can simply to our process and increase the success rate of the procedure.This kind of renal anomaly patient surprise and need one more seance for complete treatment.
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Figure I: Ct Urography Image of Triple System Horseshoe Kidney At The Coronal Plane
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Figure II: Retrograde Pyelography Image During the Flexible Ureteroscopic Lithotripsy Operation
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Figure III: Conformational Images Which Shows Three different Pelvicalyceal System with Adjacent Parenchyma