A 77-year-old female body was received through the Saint Louis University Gift of Body Program of the Center for Anatomical Science and Education (CASE) with a signed informed consent form from the donor. The CASE gift body program abides by all the rules set forth by the Uniform Anatomical Gift Act (UAGA).\nDuring routine dissection, the hilum of the left kidney was cleaned and typical anatomical structures were identified, from anterior to posterior, as the renal vein, renal artery, and superior ureteral contribution (Figures and ). Following the removal of perirenal fat, a second ureteral contribution was found exiting the kidney, slightly inferior to the hilum. The two independent contributions, superior and inferior, descended 12.4 cm and 10.6 cm before they united anterior to the left psoas major muscle to descend over the left common iliac artery to the posterolateral aspect of the bladder ().\nFurther dissection revealed an additional vascular structure, the left aberrant renal artery, entering the inferior pole of the left kidney (). Cleaning the structure revealed its origin from the abdominal aorta 4 cm inferior to the left renal artery, which branched from the aorta below the superior mesenteric artery. The aberrant renal artery was then observed travelling in parallel with, but inferior to, the left renal vein and artery toward the left kidney. This artery was also observed passing anterior to the superior and inferior ureteral contributions and bifurcated just prior to reaching the parenchyma of the inferior renal pole of the left kidney. The left ovarian artery was observed branching from the aberrant renal artery nearly halfway to the left kidney. The left ovarian artery then descended medially, but adjacent to the superior ureteral contribution, and more inferiorly, adjacent to the united ureter to supply the left ovary ().
A 73-year-old man presented with macroscopic hematuria. A pT1 g3 urothelial carcinoma was diagnosed at initial histology, while a re-TUR Bladder confirmed it. Preoperatively, an ectopic pelvic left kidney was reported. A BCG regimen was started and after 2 years a muscle-invasive bladder carcinoma was diagnosed. Staging CT showed no metastatic lesions. Radical cystoprostatectomy with standard lymphadenectomy, removing all nodal tissue cranially up to the common iliac bifurcation, was performed. Seventeen lymph nodes were excised. The ureters were anastomosed to an ileal conduit (). Final pathologic report revealed a pT2 g3 urothelial carcinoma with no involvement of any lymph nodes, while all surgical margins were clear. After 2.5 years of followup the patient remains free of disease.