BÁO CÁO TRƯỜNG HỢP LÂM SÀNG: TÁN SỎI THẬN TRÊN BỆNH NHÂN THẬN LẠC CHỖ VÙNG CHẬU TẠI BỆNH VIỆN ĐA KHOA KHU VỰC THỦ ĐỨC

Abstract

Introduction: Pelvic ectopic kidney is a rare congenital anomaly of the urinary system, with an incidence of approximately 1 in 1,000 live births. Renal calculi in ectopic kidneys are uncommon but present significant therapeutic challenges due to abnormal anatomical features. Currently, retrograde intrarenal surgery (RIRS) using a flexible ureteroscope with Holmium:YAG laser lithotripsy is a minimally invasive and increasingly adopted treatment modality.

Methods: We report a successfully treated case of renal stone in a pelvic ectopic kidney.

Case Presentation: A 48-year-old female with no significant past medical history was admitted with lower abdominal pain. Physical examination revealed mild suprapubic tenderness. Computed tomography urography demonstrated a left pelvic ectopic kidney with grade II hydronephrosis and a 17 × 15 mm renal pelvic stone, with a Hounsfield unit of approximately 1400 HU, a stone surface area of 255 mm², and a STONE score of 8. A double-J stent was initially inserted. After four weeks, the patient underwent retrograde intrarenal surgery using a flexible ureteroscope with Holmium:YAG laser set to fragmentation mode (1 J, 20 Hz, 20 W). The total operative time was 45 minutes, including 30 minutes of lithotripsy. Postoperatively, the patient achieved complete stone clearance without complications. The urethral catheter and double-J stent were removed on postoperative day 4, and the patient was discharged on postoperative day 5.

Conclusion: Renal calculi in ectopic kidneys are uncommon. We report a case successfully treated with flexible ureteroscopy, resulting in complete stone clearance without perioperative complications. Flexible ureteroscopy appears to be a safe and effective treatment option for uncomplicated stones in ectopic kidneys. Preoperative double-J stenting may facilitate ureteral access sheath placement and enhance procedural efficiency.