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Surgical and Radiologic Anatomy

, Volume 38, Issue 3, pp 293–297 | Cite as

Influence of the renal lower pole anatomy and mid-renal-zone classification in successful approach to the calices during flexible ureteroscopy

  • Bruno Marroig
  • Rodrigo Frota
  • Marco A. Fortes
  • Francisco J. Sampaio
  • Luciano Alves FavoritoEmail author
Original Article

Abstract

Purpuse

The aim of this paper is to analyze if the anatomy type of the collector system (CS) limits the accessibility of flexible ureteroscopy (FUR) in the lower pole.

Methods

We analyzed the pyelographies of 51 patients submitted to FUR and divided the CS into four groups: A1—kidney midzone (KM) drained by minor calices (Mc) that are dependent on the superior or on the inferior caliceal groups; A2—KM drained by crossed calices; B1—KM drained by a major caliceal group independent both of 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. With the use of a flexible ureteroscope, the access attempt was made to all of lower pole calices. Averages were statistically compared using the ANOVA and Unpaired T test (p < 0.05).

Results

We found 14 kidneys of A1 (27.45 %); 4 of A2 (7.84 %); 17 of B1 (33.33 %); and 16 of B2 (31.37 %). The LIP was >90° in 31 kidneys (60.78 %) and between 61° and 90° in 20 kidneys (39.22 %). We did not find angles smaller than 60°. The group A1 presented 48 Mc and the UF was able to access 42 (87.5 %); the group A2 had 11 Mc and the UF was able to access 7 (63.64 %); the group B1 had 48 Mc and the UF was able to access 41 (85.42 %) and in group B2 we observed 41 Mc and the UF could access 35 (85.36 %). There was no statistical difference in the accessibility between the groups (p = 0.2610).

Conclusions

Collecting system with kidney midzone drained by crossed calices presented the lower accessibility rate during FUR.

Keywords

Flexible ureteroscopy Kidney anatomy Lower pole anatomy 

Notes

Acknowledgments

This study was supported by grants from the National Council for Scientific and Technological Development (CNPq–Brazil) and the Rio de Janeiro State Research Foundation (FAPERJ).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest as statement in the manuscript.

References

  1. 1.
    El-Assmy A, Abo-Elghar ME, El-Nahas AR et al (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 CrossRefPubMedGoogle Scholar
  2. 2.
    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 159:676–682Google Scholar
  3. 3.
    El Nahas AR, Ibrahim HM, Youssef RF et al (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 CrossRefPubMedGoogle Scholar
  4. 4.
    Geavlete P, Multescu R, Geaviete B (2008) Influence of pyelocaliceal anatomy on the success of flexible ureteroscopic approach. J Endourol 22:2235–2239. doi: 10.1089/end.2008.9719 CrossRefPubMedGoogle Scholar
  5. 5.
    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 CrossRefPubMedGoogle Scholar
  6. 6.
    Gupta NP, Singh DV, Hemal AK et al (2000) Infundibulopelvic anatomy and clearance of inferior caliceal calculi with shock wave lithotripsy. J Urol 163:24–27CrossRefPubMedGoogle Scholar
  7. 7.
    Hussain M, Acher P, Penev B et al (2011) Redefining the limits of flexible ureteroscopy. J Endourol 25:45–49. doi: 10.1089/end.2010.0236 CrossRefPubMedGoogle Scholar
  8. 8.
    Jessen JP, Honeck P, Knoll T et al (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 CrossRefPubMedGoogle Scholar
  9. 9.
    Jones JK, Krow A, Hariharan S et al (2008) Measuring angles on digitalized radiographic images using Microsoft PowerPoint. West Indian Med J 57:14–19PubMedGoogle Scholar
  10. 10.
    Knoll T, Musial A, Trojan L et al (2003) Measurement of renal anatomy for prediction of lower-pole caliceal stone clearance: reproducibility of different parameters. J Endourol 17:447–451CrossRefPubMedGoogle Scholar
  11. 11.
    Kumar PVS, Joshi HB, Keeley FX et al (2000) An acute infundibulopelvic angle predicts failure of flexible ureteroscopy for lower calyceal stones. J Urol 163:339AGoogle Scholar
  12. 12.
    Marroig B, Favorito LA, Fortes MA, Sampaio FJB (2015) Lower pole anatomy and mid-renal-zone classification applied to flexible ureteroscopy: experimental study using human three-dimensional endocasts. Surg Radiol Anat. doi: 10.1007/s00276-015-1503y (epup ahead of print) Google Scholar
  13. 13.
    Miller J, Durack JC, Sorensen MD et al (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 CrossRefPubMedGoogle Scholar
  14. 14.
    Multescu R, Geavlete B, Georgescu D et al (2009) Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: a critical comparison. J Endourol 24:17–21. doi: 10.1089/end.2009.0390 CrossRefGoogle Scholar
  15. 15.
    Preminger GM (2006) Management of lower pole renal calculi: shock wave lithothripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res 34:108–111CrossRefPubMedGoogle Scholar
  16. 16.
    Resorlu B, Oguz U, Resorlu EB et al (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 CrossRefPubMedGoogle Scholar
  17. 17.
    Sampaio FJB (2000) Renal anatomy: endourologic considerations. Urol Clin North Am 27:585–607CrossRefPubMedGoogle Scholar
  18. 18.
    Sampaio FJ, Aragao AH (1992) Inferior pole collecting system anatomy: its probable role in extracorporeal shock wave lithotripsy. J Urol 147:322–324PubMedGoogle Scholar
  19. 19.
    Sampaio FJB, D’Anunciação AL, Silva ECG (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 11:157–161CrossRefPubMedGoogle Scholar
  20. 20.
    Sampaio FJ, Mandarim de Lacerda CA (1988) Anatomic classification of the kidney collecting system for endourologic procedures. J Endourol 2:247–251CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2015

Authors and Affiliations

  • Bruno Marroig
    • 1
  • Rodrigo Frota
    • 1
  • Marco A. Fortes
    • 1
  • Francisco J. Sampaio
    • 1
  • Luciano Alves Favorito
    • 1
    Email author
  1. 1.Urogenital Research UnitState University of Rio de JaneiroRio de JaneiroBrazil

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