Top

Surgical and Radiologic Anatomy

Published in:

01-12-2015 | Original Article

Lower pole anatomy and mid-renal-zone classification applied to flexible ureteroscopy: experimental study using human three-dimensional endocasts

Authors: Bruno Marroig, Luciano Alves Favorito, Marco A. Fortes, Francisco J. B. Sampaio

Published in: Surgical and Radiologic Anatomy | Issue 10/2015

Abstract

Purpuse

The aim of this study was to analyze the anatomy of the inferior pole collecting system and the mid-renal-zone classification in human endocasts applied to flexible ureteroscopy.

Methods

170 three-dimensional polyester resin endocasts of the kidney collecting system were obtained from 85 adult cadavers. We divided the endocasts into four groups: A1—kidney midzone (KM), drained by minor calices (mc) that are dependent on the superior or the inferior caliceal groups; A2—KM drained by crossed calices; B1—KM drained by a major caliceal group independent of both the superior and inferior groups; and B2—KM drained by mc entering directly into the renal pelvis. We studied the number of calices, the angle between the lower infundibulum and renal pelvis and the angle between the lower infundibulum and the inferior mc (LIICA). Means were statistically compared using ANOVA and the unpaired T test (p < 0.05).

Results

We found 57 (33.53 %) endocasts of group A1; 23 (13.53 %) of group A2; 59 (34.71 %) of group B1; and 31 (18.23 %) of group B2. The inferior pole was drained by four or more calices in 84 cases (49.41 %), distributed into groups as follows: A1 = 35 cases (41.67 %); A2 = 18 (21.43 %); B1 = 22 (26.19 %); and B2 = 9 (10.71 %). Perpendicular mc were observed in 15 cases (8.82 %). We did not observe statistical differences between the LIICA in the groups studied.

Conclusions

Collector systems with kidney midzone drained by minor calices that are dependent on the superior or on the inferior caliceal groups presented at least two restrictive anatomical features. The mid-renal-zone classification was predictive of anatomical risk factors for lower pole ureteroscopy difficulties.

Albala DM, Assimos DG, Clayman RV et al (2001) Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotrispsy and percutaneous nephrostolithothomy for lower pole nephrolithiasis-initial results. J Urol 166:2072–2080CrossRefPubMed

Cohen J, Cohen S, Grasso M (2013) Ureteropyeloscopic treatment of large, complex intrarenal and proximal ureteral calculi. BJU Int 111:127–131. doi:10.1111/j.1464-410X.2012.11352.x CrossRef

El-Assmy A, Abo-Elghar ME, El-Nahas AR, Youssef RF, El-Diasty T, Sheir KZ (2008) Anatomic predictors of formation of lower caliceal calculi: is it the time for three-dimensional computed tomography urography? J Endourol 22:2175–2179. doi:10.1089/end.2008.0148 CrossRefPubMed

Elbahnasy AM, Clayman RV, Shalhav AL et al (1998) Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Endourol 159:676–682

El Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ (2012) Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10–20 mm. BJU Int 110:898–902. doi:10.1111/j.1464-410X.2012.10961.x CrossRefPubMed

Filho DR, Favorito LA, Costa WS, Sampaio FJ (2009) Kidney lower pole pelvicaliceal anatomy: comparative analysis between intravenous urogram and three-dimensional helical computed tomography. J Endourol 12:2035–2040. doi:10.1016/j.urology.2009.04.071 CrossRef

Geavlete P, Multescu R, Geaviete B (2008) Influence of pyelocaliceal anatomy on the sucess of flexible ureteroscopic approach. J Endourol 22:2235–2239. doi:10.1089/end.2008.9719 CrossRefPubMed

Ghani KR, Bultitude M, Hegarty N, Thomas K, Glass J (2012) Flexible ureterorenoscopy (URS) for lower pole calculi. BJU Int 110:294–298. doi:10.1111/j.1464-410X.2012.10616.x CrossRefPubMed

Gupta NP, Singh DV, Hemal AK, Suhnasis M (2000) Infundibulopelvic anatomy and clearance of inferior caliceal calculi with shock wave lithotripsy. J Urol 163:24–27CrossRefPubMed

10.

Hussain M, Acher P, Penev B, Cynk M (2011) Redefining the limits of flexible ureteroscopy. J Endourol 25:45–49. doi:10.1089/end.2010.0236 CrossRefPubMed

11.

Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, Matsuzaki J (2013) Evaluation of preoperative measurement of stone surface area as a predictor of stone-free status after combined ureteroscopy with holmium lases lithotripsy: a single center experience. J Endourol 27:715–721. doi:10.1089/end.2012.0548 CrossRefPubMed

12.

Jessen JP, Honeck P, Knoll T, wendt-Nordahl G (2014) Flexible ureteroreoscopy for lower pole stones: influence of the collecting system’s anatomy. J Endourol 28:146–151. doi:10.1089/end.2013.0401 CrossRefPubMed

13.

Jones JK, Krow A, Hariharan S, Weeks L (2008) Measuring angles on digitalized radiographic images using Microsoft PowerPoint. West Indian Med J 57:14–19PubMed

14.

Knoll T, Jessen JP, Honeck P, Wendt-Nordahi G (2011) Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30mm size. World J Urol 29:755–759. doi:10.1007/s00345-011-0784-y CrossRefPubMed

15.

Knoll T, Musial A, Trojan L, Ptahnyk T, Michel MS, Alken P, Kohrmann KU (2003) Measurement of renal anatomy for prediction of lower-pole caliceal stone clearance: reproducibility of different parameters. J Endourol 7:447–451CrossRef

16.

Kumar PVS, Joshi HB, Keeley FX, Timoney AG (2000) An acute infundibulopelvic angle predicts failure of flexible ureteroscopy for lower calyceal stones. J Urol 163:339A

17.

Miller J, Durack JC, Sorensen MD, Wang JH, Stoller ML (2013) Renal calyceal anatomy characterization with 3-dimensional in vivo computerized tomography imaging. J Urol 189:562–567. doi:10.1016/j.juro.2012.09.040 CrossRefPubMed

18.

Preminger GM (2006) Management of lower pole renal calculi: shock wave lithothripsy versus percutaneous nephrolithotomy versus flexible ureteroscpy. Urol Res 34:108–111CrossRefPubMed

19.

Resorlu B, Oguz U, Resorlu EB, Oztuna D, Unsal A (2012) The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology 79:61–66. doi:10.1016/j.urology.2011.06.031 CrossRefPubMed

20.

Sampaio FJB (2000) Renal anatomy: endourologic considerations. Urol Clin North Am 27:585–607CrossRefPubMed

21.

Sampaio FJ, Aragao AH (1992) Inferior pole collecting system anatomy: its probable role in extracorporeal shock wave lithotripsy. J Urol 147:322–324PubMed

22.

Sampaio FJB, D’Anunciação AL, Silva EC (1997) Comparative follow-up of patients with acute and obtuse infundibulum-pelvic angle submitted to extracorporeal shockwave lithotripsy for lower caliceal stones: preliminary report and proposed study design. J Endourol 11:157–161CrossRefPubMed

23.

Sampaio FJ, Mandarim de Lacerda CA (1988) Anatomic classification of the kidney collecting system for endourologic procedures. J Endourol 2:247–251CrossRef

Title: Lower pole anatomy and mid-renal-zone classification applied to flexible ureteroscopy: experimental study using human three-dimensional endocasts
Authors: Bruno Marroig
Luciano Alves Favorito
Marco A. Fortes
Francisco J. B. Sampaio
Publication date: 01-12-2015
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 10/2015
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-015-1503-y

At a glance: The STEP trials

Springer Medicine

Lower pole anatomy and mid-renal-zone classification applied to flexible ureteroscopy: experimental study using human three-dimensional endocasts

Abstract

Purpuse

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpuse

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2015

Letter to the editor regarding “Situs inversus with levocardia, infrahepatic interruption of the inferior vena cava, and azygos continuation: a case report”

Lymph nodes behind the axillary neurovascular bundle: case report and cadaveric study of frequency and distribution

The umbilicus: a reliable surface landmark for the aortic bifurcation?

Femoral curvature variability in modern humans using three-dimensional quadric surface fitting

Extraordinary cerebral venous drainage pathway with mastoid emissary and posterior external jugular veins detected by contrast-enhanced neck computed tomography

Is the decline of human anatomy hazardous to medical education/profession?—A review