Hand-Assisted Laparoscopic Nephroureterectomy with Cystoscopic en-bloc Excision of the Distal Ureter and Bladder Cuff and Isthmusectomy in a Horseshoe Kidney for Invasive Urothelial Carcinoma of the Renal Pelvis

Upper tract invasive urothelial carcinoma and horseshoe kidneys are familiar to the practicing urologist but relatively rare individual entities. The complication of managing them when they coexist in the same patient can be challenging. Herein, we present the first reported case in which an upper tract invasive urothelial carcinoma in a horseshoe kidney was successfully managed with a combined hand-assisted laparoscopic nephroureterectomy and isthmusectomy with cystoscopic en-bloc excision of the distal ureter and bladder cuff. This highlights the fact that complex anatomy can be managed in a completely minimally invasive fashion, and sound oncologic principles can still be maintained.