Résumé
Objective:To investigate the typing and clinical value of posterior group renal calyces.Methods:From April 2020 to June 2021, 640 patients (320 men and 320 women) who underwent CTU examination in our hospital with kidneys on both sides and normal or only mild hydronephrosis in the collecting system were analyzed. A total of 1 280 renal CTU three-dimensional reconstructed images were counted.The patients aged 52.4±11.9 years. The patients' CTU images were reconstructed in three dimensions using the spine as a marker to rotate the collecting system images in stereoscopic space to simulate a prone position. A two-person review was taken to observe the imaging morphology of the renal calyces in the prone position, and the 640 renal calyces in the posterior group of the left and right sides were counted for staging. Based on the morphology of the renal calyces and the influence on the establishment of surgical access, the posterior group of renal calyces was divided into 3 major types. Pot-belly type: the renal pelvis is shaped like a pot-belly, and the renal pelvis is directly connected to the cup-shaped minor calyces without a distinct major renal calyces. Classically branched: 2 or more major renal calyces are branched and converge to form the renal pelvis. Elongated branched: the major calyces are branched, with at least one major calyces having an axis length ≥0.9cm and a neck width ≤0.3cm.The classic branching type is divided into three types, a, b, and c, including seven subtypes, based on the relationship of the posterior group of the minor calyces to the major calyces. Type a is derived from group 1 major calyces only, type b is derived from group 2 major calyces at the same time, and type c is derived from the upper, middle and lower groups of major calyces at the same time. Type a contains 3 subtypes.Type a1 is derived from the upper group of major calyces only, type a2 is derived from the middle group of major calyces only, and type a3 is derived from the lower group of major calyces only. Type b is also divided into 3 subtypes. Type b1 is derived from the upper and middle groups of major calyces at the same time, type b2 is derived from the middle and lower groups of major calyces at the same time, and type b3 for the upper and lower renal major calyces. Type c had no corresponding subtype.Results:Statistical findings revealed that all kidneys had posterior group calyces. The morphological typing of the posterior group of calyces was 8.83% (113/1 280) for the pot-bellied type, which had the highest occurrence of 2 minor calyces (5.63%, 72/1 280). 71.25% (912/1 280) had the classically branched type, which had the highest occurrence of 3 minor calyces (31.17%, 399/1 280). 19.92% (255/1 280) had the elongated branched type, with the highest percentage of 3 occurring in the calyces (9.92%, 127/1 280). The anatomical typing of the classical branching type occurred in 20.50% (187/912) for type a, 66.45% (606/912) for type b, and 13.05% (119 /912) for type c. The percentage of occurrence of type a1/a2/a3 was 4.06% (37/ 912), 6.14% (56/ 912), and 10.31% (94/912). b1/b2/b3 types occurred in 2.03% (21/912), 7.46% (68/912), and 56.69% (517/912), respectively.Conclusions:The posterior group of calyces is structurally complex and extremely variable. In this study, the posterior group calyces were found to be present in all patients, and the posterior group calyces were morphologically divided into 3 types, with the highest percentage of occurrence of the classical branching type and the highest percentage of 3 posterior group minor calyces. The classical branching anatomical typing was highest in type b with the highest percentage of type b3, which combined with stone distribution, made it easy to choose the puncture location. The typing of the posterior group of calyces can provide an anatomical basis for PCNL puncture from the posterior group.
Résumé
Objectives: To know the pelvicalyceal anatomy by radiological method that helps in localizing the calculi or tumors in kidneys. Materials and method: The study was conducted in Sri Devaraj Urs Medical College, Tamaka, Kolar from 2011 to 2013. Forty four adult, formalin embalmed cadaveric kidneys (20 right and 24 left) were injected with 8 to 10 ml of 10% radio opaque barium sulphate solution into the renal pelvis and calyces and radiographs were taken in anteroposterior view. Results: The observations were statistically analyzed. There were 14 extra renal pelves and 30 intra renal pelves. The major calyces were classified into three categories [Double (D), Three (T) and Multiple (M) divisions]. Out of 44 kidneys 20 were right and 24 left.. 23 kidneys presented multiple (more than 4) calyces, 12 had two major calyces and only 9 presented with three major calyces). Typical ‘Y’ arrangement in 03 out of 12 and typical multiple in 03 out of 23 kidneys. There were 14 kidneys (31.8%) presented with extra renal pelvis whereas 30 kidneys (68.2%) presented intrarenal formation of the renal pelvis. Conclusion: Due to the variation in the number of major and minor calyces, position of renal pelvis (intrarenal and extra renal), the knowledge of pelvicalyceal anatomy will help the urologist and nephrologists to pin point the position of renal calyceal calculi or malignant growth for the surgery to be carried out.
Résumé
Objective To evaluate the efficacy of calicecotomy combined with trans-renal parenchyma pneumatic lithotripsy for complicated staghorn renal calculi.Methods The severe hydrocalycosis was incised using electrocautery,then pneumatic lithotripsy was performed and the broken stones were taken out.For those patients with stenotic entrance to renal calyces without hydrocalycosis,we stabbed into the stones with the lithotriptic pole(1 mm in diameter) through renal parenchyma and took the broken stones out of the entrance.Results The renal pedicle were not blocked in 19 cases.The operation time was 90-150 minutes,with a mean of 120 minutes.There was no blood transfusion with the blood loss ranging form 100 to 250 ml.The procedures were successful in 17 cases without residual stones after operation;intraoperative residual sand-like calculi were found in 1 case and removed by irrigation and drainage through nephrostomy tube;intraoperative missing calyceal calculi occurred in 1 case and were cleared by extracorporeal shock wave lithotripsy(ESWL).A follow-up for 10-60 months(mean,18 months)in 15 patients showed recurrence in 2 ones,and the stones were removed by ESWL.Conclusions Calicecotomy combined with trans-renal parenchyma pneumatic lithotripsy for complicated staghorn renal calculi has the advantages of less blood loss and definite efficacy.