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The stone disease in a pelvic kidney is often difficult to treat due to the multiple anatomical anomalies. We have performed a laparoscopic pyelolithotomy for a large pelvic kidney stone with guided intraoperative flexible ureteroscopy. We have successfully performed a peritoneal transmesocolic laparoscopic pyelolitotomy to a 35-year old female patient with a 23 mm stone located in the collecting system of her right pelvic kidney. During the operation we also used a flexible ureteroscope to identify the stone due to an aberrant disposition of the right collecting system. Operative time was of 5 hours with no injury of major blood vessels. Postoperative recovery was four days with minimal abdominal pain, minimal abdominal drainage, no urine leakage in the peritoneal cavity and fast retrieval of gastrointestinal function. At this point the patient is stone free and the kidney has normal function demonstrated in a renal scintigraphy. Laparoscopic pyelolithotomy is a safe and efficient treatment option for stone disease with large calculi in ectopic pelvic kidney. The advantage of laparoscopic pyelolithotomy is that it has good functional results, with fast postoperative recovery, low complication rates and high stone free rate in one session. [ABSTRACT FROM AUTHOR]

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Introduction. Neuroendocrine renal carcinoma represents less than 1% of all primary neoplasia of the kidney. Most frequently poorly differentiated carcinoma is diagnosed in advanced stages and they have an aggressive evolution and limited survival rate. Neuroendocrine carcinomas that arise from the renal pelvis are frequently associated with squamous cell carcinoma or adenocarcinoma. Material and method. We present the case of a female patient, known for 3 years before with an undefined retroperitoneal lymph node metastasis, being diagnosed at present with a left large cell neuroendocrine renal carcinoma, who initially had lymph node metastasis. Results. Until now, 118 cases of primary neuroendocrine renal carcinomas have been reported. A limited number of poorly differentiated neuroendocrine carcinomas have been reported. Discussion. Due to the clinical and biological findings, the aggressive evolution with early metastasis of lung and bone, the patient is included in the group of poorly differentiated carcinomas. In these cases, multimodal treatment is a gold standard. After surgical treatment and palliative chemotherapy with platinum salts, we obtained a partial remission of the disease and the control of symptoms. Conclusions. Regarding large cell neuroendocrine carcinoma, the surgical treatment remains the treatment of choice. Chemotherapy can determine limited results, improve the quality of life and enhance the overall survival rate. [ABSTRACT FROM AUTHOR]