Skip to main content
SpringerLink
Log in

Endoscopic description of renal papillary abnormalities in stone disease by flexible ureteroscopy: a proposed classification of severity and type

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Introduction

The goal of this original work was to describe papillary abnormalities using flexible ureteroscopy into a new classification and to assess their relation with stone composition.

Patients and methods

We performed a prospective monocentric single-operator study aiming to describe various aspects of renal papillae. Data have been prospectively collected during consecutive 164 sequential flexible ureterorenoscopies required for the treatment of renal stones from May 2011 to March 2015. The collected stones have been examined by microscopy and infrared spectrometry. Serum and urine biochemical samples have been systematically analyzed.

Results

A total of 74 patients (45.1 %) had renal papillary abnormalities on at least one papilla, excluding typical Randall’s deposits alone. Various abnormalities were reported, some of them being present in the same patient: tip papillary erosions (51.3 %), anchored papillae calculi (47.3 %), subepithelial stones (18.9 %), cryptic papillae (10.8 %), extrophic papillae (9.46 %) and intraductal deposits (2.7 %). Associations between papillary abnormalities and stone types were found. Intraductal deposits were systematically associated with carbonate apatite IVa2 stones and hypocitraturia. A “first step” classification has been established to standardize the description of these papillary abnormalities for future reports and studies.

Conclusions

This study highlights the necessity of papillary abnormalities description in further multicentric studies and ureteroscopy’s reports. The established classification needs multicentric evaluation and validation. The endoscopic observation and knowledge of pathological aspects of the papillae should help to better understand pathogenesis of nephrolithiasis. Medical or surgical treatments of some abnormalities should be also discussed and evaluated to improve the prevention of stone recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

Abbreviations

COM:

Calcium oxalate monohydrate

COD:

Calcium oxalate dihydrate

HAP:

Hydroxyapatite

CA:

Carbonate apatite

PTH:

Parathormone

CaOx:

Calcium oxalate

UA:

Uric acid

MSK:

Medullary sponge kidney

References

  1. Randall A (1937) Origin and growth of renal calculi. Ann Surg 105:1009–1027

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kuo RL, Lingeman JE, Evan AP, Paterson RF, Bledsoe SB, Kim SC, Munch LC, Coe FL (2003) Endoscopic renal papillary biopsies: a tissue retrieval technique for histological studies in patients with nephrolithiasis. J Urol 170(6 Pt 1):2186–2189

    Article  PubMed  Google Scholar 

  3. Daudon M, Bader CA, Jungers P (1993) Urinary calculi: review of classification methods and correlations with etiology. Scan Microsc 7(3):1081–1106

    CAS  Google Scholar 

  4. Low RK, Stoller ML (1997) Endoscopic mapping of renal papillae for Randall’s plaques in patients with urinary stone disease. J Urol 158(6):2062–2064

    Article  CAS  PubMed  Google Scholar 

  5. Borofsky MS, Paonessa JE, Evan AP, Williams JC Jr, Coe FL, Worcester EM, Lingeman JE (2016) A proposed grading system to standardize the description of renal papillary appearance at the time of endoscopy in patients with nephrolithiasis. J Endourol 30(1):122-7. doi:10.1089/end.2015.0298

    Article  PubMed  Google Scholar 

  6. Grases F et al (2013) Renal papillary calcification and the development of calcium oxalate monohydrate papillary renal calculi: a case series study. BMC Urol 13:14

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Daudon M, Bazin D, Letavernier E (2015) Randall’s plaque as the origin of calcium oxalate kidney stones. Urolithiasis 43(Suppl 1):5–11

    Article  CAS  PubMed  Google Scholar 

  8. Bazin D, Daudon M (2010) New techniques of analysis of lithiasis and Randall’s plaque. Les actualités néphrologiques. 75–98

  9. Matlaga BR, Williams JC Jr, Kim SC, Kuo RL, Evan AP, Bledsoe SB, Coe FL, Worcester EM, Munch LC, Lingman JE (2006) Endoscopic evidence of calculus attachment to Randall’s plaque. J Urol 175(5):1720–1724

    Article  PubMed  Google Scholar 

  10. Viers BR, Lieske JC, Vrtiska TJ, Herrera Hernandez LP, Vaughan LE, Mehta RA, Bergstrahl EJ, Rule AD, Holmes DR, Krambeck AE (2015) Endoscopic and histologic findings in a cohort of uric acid and calcium oxalate stone formers. Urology 85(4):771–776

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lizee D, Al-Quatani S, Abdourrahmane H, Ahaisni M et al (2012) Approche endoscopique du traitement des calculs rétropapillaires dans la maladie de Cacci Richi grâce à l’urétérorénoscopie rétrograde. Progrès en Urologie 22(13):804

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Saint Jean Languedoc Clinic, 20 Route de Revel, CS37707, 31077, Toulouse Cedex 4, France

    Christophe Almeras, Guillaume Ploussard & Jean Romain Gautier

  2. Unit of Functional Explorations, Tenon Hospital, Pierre and Marie Curie University, Paris, France

    Michel Daudon

  3. Department of Urology, Tenon Hospital, Pierre and Marie Curie University, Paris, France

    Olivier Traxer

  4. Department of Urology, Saint-Louis Hospital, Denis Diderot University, Paris, France

    Paul Meria

Authors
  1. Christophe Almeras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michel Daudon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guillaume Ploussard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Romain Gautier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olivier Traxer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul Meria
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christophe Almeras.

Ethics declarations

Conflict of interest

All authors have no commercial association that might create a conflict of interest in connection with the submitted manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Almeras, C., Daudon, M., Ploussard, G. et al. Endoscopic description of renal papillary abnormalities in stone disease by flexible ureteroscopy: a proposed classification of severity and type. World J Urol 34, 1575–1582 (2016). https://doi.org/10.1007/s00345-016-1814-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-016-1814-6

Keywords

Search

Navigation