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

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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.

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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).

Conflict of interest

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

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Authors and Affiliations

  1. Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil

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

  2. Rua Professor Gabizo, 104/201, Tijuca, Rio de Janeiro, RJ, 20271-320, Brazil

    Luciano Alves Favorito

Authors
  1. Bruno Marroig
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  2. Luciano Alves Favorito
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  3. Marco A. Fortes
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  4. Francisco J. B. Sampaio
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Correspondence to Luciano Alves Favorito.

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Marroig, B., Favorito, L.A., Fortes, M.A. et al. Lower pole anatomy and mid-renal-zone classification applied to flexible ureteroscopy: experimental study using human three-dimensional endocasts. Surg Radiol Anat 37, 1243–1249 (2015). https://doi.org/10.1007/s00276-015-1503-y

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  • DOI: https://doi.org/10.1007/s00276-015-1503-y

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