A 68-year-old man presented with macroscopic hematuria. The diagnostic ultrasound revealed a bladder tumor. The Computed Tomography (CT)-scan showed no prevalent metastatic lesions, while an ectopic left pelvic kidney was discovered (). The biopsy showed a high grade muscle invasive urothelial carcinoma. Radical cystoprostatectomy with extended lymphadenectomy was performed with conversion to an ileal pouch (). Twenty-one lymph nodes were resected. The final pathology showed a pT2aG3 urothelial carcinoma and multiple sites of urothelial in situ carcinoma. There are no signs of metastatic disease 1.5 years after cystectomy.
A 36-year-old woman was admitted to our hospital with intermittent right flank pain for 4 years. The pain-free interval had been shortened when she sought medical attention. The pain was dull and confined to the right upper quadrant anteriorly and posteriorly. The pain was most often experienced during the later hours of the day, especially after ingestion of large quantities of fluid. She had been treated at a local clinic in the past for urinary tract infection with right flank pain and weakness. Physical examination revealed blood pressure of 110/80 mmHg and the presence of costovertebral-angle tenderness. Urinalysis were within normal limits (WBC 0-1/HPF, RBC 0-1/HPF). Biochemical analysis revealed blood urea nitrogen level of 11.0 mg/dL and serum creatinine level of 0.8 mg/dL.\nKidney ultrasonogram showed a marked dilatation of the right pelvocalyceal system and right proximal ureter. However, the left kidney showed normal appearance. Excretory urogram revealed a marked right hydronephrosis with dilated calyces due to ureteropelvic junction obstruction (). Computed tomography angiogram (CTA) clearly displayed the aberrant renal artery which originated from the aorta below the normal right renal artery (). A source image of magnetic resonance angiogram (MRA) also showed a severe hydronephrosis of the right kidney and smooth obstruction of the right ureteropelvic junction due to extrinsic compression by an aberrant renal artery which originated from the aorta, crossing anteriorly to the ureteropelvic junction (). Retrograde pyelogram demonstrated linear indentation of the proximal ureter (). Tc-99m DTPA renal scan revealed a markedly delayed excretion of the right kidney. After furosemide infusion, the delayed right kidney excretion was somewhat improved ().\nThe patient underwent surgical exploration via an anterior approach which revealed a slightly ptotic, mobile, right kidney which was normal in size, with a marked hydronephrotic pelvis froman aberrant renal artery and vein crossing the ureteropelvic junction, proceeding to the lower pole and compressing the ureteropelvic junction against the lower pole of the kidney. A dismembered pyeloplasty was performed, with the pelvis anastomosed to the ureter in front of the aberrant renal artery.