Laparoscopic left hemi-nephroureterectomy for a patient with suspected urothelial carcinoma in a horseshoe kidney

A 76-year-old gentleman with a background of benign prostatic hyperplasia, hiatus hernia and anxiety was referred to the rapid access haematuria service following an episode of painless visible haematuria. Flexible cystoscopy did not reveal any concerning bladder lesions. CT Urogram demonstrated a horseshoe kidney with a filling defect in the left upper pole moiety suspicious for an urothelial carcinoma. The patient was subsequently referred to the urology services in a tertiary centre. Flexible ureterorenoscopy was performed, with findings of a likely urothelial carcinoma corresponding to the suspicious area on imaging. Biopsy of this lesion revealed a low grade urothelial cancer. The patient proceeded to have a laparoscopic left heminephroureterectomy with an open bladder cuff. The patient recovered well and urinary catheter was removed Day 12 post procedure after the performance of a cystogram. Histology revealed a favourable pTa low grade malignancy, and the patient will require ongoing follow-up moving forward. This case report highlights the operative intricacies in managing patients with horseshoe kidney due to anatomic variations associated with this condition.