Variations of Middle Segmental Artery of Human Kidney and Clinical Significance.

Aim: To assess the arterial pattern of middle segmental artery and its relation with collecting system in the human kidneys. Materials and Methods: We studied 50 fresh human Kidneys by corrosion cast techniques. We used different colour coded moulding granules of butyl butyrate, red for artery, blue for vein and black for collecting system of the human kidneys. 20% solution of butyl butyrate in acetone was injected into renal vessels and ureter of each kidney. Injected kidneys were kept immersed in concentrated Potassium Hydroxide solution for corrosion to obtain the endocasts. These endocasts were cleaned under the running tap water and observed macroscopically. Results: We observed three types of variations in arterial pattern of middle segmental artery namely Middle Segmental Artery Type-1 (MSAT1), Middle Segmental Artery Type-2 (MSAT2), Middle Segmental Artery Type-3 (MSAT3) and they were seen in 29(58%), 14(28%), 6(12%) kidneys respectively. We also observed three different variations in relation between middle segmental artery and collecting system namely Middle Segmental Artery Group-1 (MSAG1), Middle Segmental Artery Group-2 (MSAG2), Middle Segmental Artery Group-3 (MSAG3) and they were seen in 32%, 24%, 42% kidneys respectively. Conclusion: Anatomical knowledge of these variations is of valuable contribution for uro-surgeon in performing more and more conservative renal surgeries which lead to preservation of healthy and functional renal parenchyma and prevent intraoperative and post-operative complications.

Anatomical Variations In Arterial Pattern Of Lower Segmental Artery And Its Relation With Collecting System.

Aim of our study to observe the arterial pattern of lower segmental artery and its relation with collecting system. 50 fresh human Kidneys were studied by corrosion cast method. Moulding granules of butyl butyrate dissolved in acetone for 24 hours and prepared 20% homogenous solution. Solution was injected into renal vessel and ureter. Injected Kidney was corroded in concentrated potassium hydroxide solution and cleaned with running water. We observed three dimensional endocasts of collecting system and renal vessel. We found 5 types of variation in arterial pattern of lower segmental artery namely LSAT1, LSAT2, LSAT3, LSAT4, LSAT5 and they were seen in 70%, 4%, 2%, 4% and 20% Kidneys respectively. We also found two types of variation in relation between lower segmental artery and collecting system namely LSAG1 and LSAG2. LSAG1 seen in 80% Kidneys and LSAG2 in 20% Kidneys.The finding of our study is helpful for urosurgeon in intrarenal operations, endourological stone removal, renal trauma management and to avoid post operative complications.

Artery to Collecting System Communication after Abdominal Trauma

Degenerative vascular disease, previous arterial surgery, long-term ureteral stenting, pelvis surgery, and radiotheraphy are reported as causes of artery-to-collecting-system communication.. Artery-to-collecting-system- communication associated with blunt trauma is rare, but potentially fatal. The diagnosis is very difficult and requires a high degree of suspicion. We were able to make the diagnosis based on the characteristic finding of contrast-enhanced computed tomography (CT) obtained in the early phase, equivalent to the finding obtained in the corticomedullary phase of the kidney. We report a case of artery to collecting system communication due to blunt abdominal trauma following a fall, which was treated by embolization.

Artery to Collecting System Communication after Abdominal Trauma

Degenerative vascular disease, previous arterial surgery, long-term ureteral stenting, pelvis surgery, and radiotheraphy are reported as causes of artery-to-collecting-system communication.. Artery-to-collecting-system- communication associated with blunt trauma is rare, but potentially fatal. The diagnosis is very difficult and requires a high degree of suspicion. We were able to make the diagnosis based on the characteristic finding of contrast-enhanced computed tomography (CT) obtained in the early phase, equivalent to the finding obtained in the corticomedullary phase of the kidney. We report a case of artery to collecting system communication due to blunt abdominal trauma following a fall, which was treated by embolization.

First-line Treatment Modality in Children with Complete Duplicating System Complicated with Ureterocele or Ectopic Ureter: Ureteropyelostomy / 대한비뇨기과학회지

PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.

First-line Treatment Modality in Children with Complete Duplicating System Complicated with Ureterocele or Ectopic Ureter: Ureteropyelostomy / 대한비뇨기과학회지

PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.

Duplicated Collecting System with Lower Pole Ureteropelvic Junct ion Obstruction

Two examples of the rare case of complete duplicated collecting system with lower pole ureteropelvic junction obstruction are described. Ureteropelvic junction obstruction (UPJO) and duplicated collecting systems seldom occur in combination. Complete duplication of the ureter may be asymptomatic or recognized when complications develop as a result of reflux into the lower pole ureter or obstruction of the upper pole with an ectopic ureterocele. It is difficult to choose an optimal therapy due to the high variability in function, degree of obstruction, damage and potential for regeneration in growing kidneys. The diagnosis and management of UPJO of the lower pole in complete duplicated collecting systems are discussed.