A Cadaveric Study Of Variations In The Urological System

Introduction: Knowledge of anatomical variations of the urinary system is important for urological surgeriesinvolving renal transplant and radiological interpretations. When urologists and clinicians have a soundknowledge of anatomical variations, it eases management, surgical interventions and helps to reducecomplications.Advanced imaging technology is the boon for the patients requiring minimally invasive approaches for variouskidney disorders. These approaches require precise knowledge of normal and variant anatomy of the kidneys,ureters and vascular structures at the hilum of the kidney. Therefore, the objective of this study was to furnish theclinicians with the major anatomical variations of urological system.Method: Ninety adult human cadavers were examined for number, shape and position of kidneys and the uretersover a period of 5 years. Out of these, 85 were males and 15 were female cadavers.Results: Kidneys were bilaterally present in all the cadavers. Hypoplastic kidneys were seen bilaterally in 3.3%cadavers. Out of 90 cadavers, 3 showed bilateral and 6 showed unilateral lobulated kidneys. 2 cadavers showedunilateral (1 L, 1 R) incomplete double ureter. One showed bilateral and 5 showed unilateral accessory renalartery amongst 90 cadavers. Ectopic kidney was seen in one cadaver.Conclusions: Morphological variations in the kidney are very common and are clinically important for urosurgeons

Study Of Arrangement Of Renal Hilar Structures In Human Cadavers

Background: Renal hilum is the middle concavity of the medial border of kidney which communicates with renalsinus. The disposition of renal hilar structures has been described in anatomical textbook from anterior toposterior as the renal vein, renal artery and renal pelvis. Variations in arrangement of renal hilar structureswere detected incidentally while performing investigative imaging and angiographic procedures. Anatomicalknowledge of structures at the renal hilum is of great importance for various urological surgical procedures andalso during interpretation of various radiological techniques related to the kidney.Objective: To evaluate the arrangement of renal hilar structures in human cadaversMaterials and Methods: Present work was carried out in the Department of Anatomy, Sri Devaraj Urs medicalcollege, Kolar on fifty pairs of morphological normal kidneys of embalmed cadavers. Renal hilum of each kidneywas dissected carefully to see the arrangement of renal artery, vein and pelvis and their anteroposterior relationsat the hilum were recorded.Results: The arrangement of renal hilar structures exhibited great variations. The patterns of arrangement of thehilar structures were classified into 12 major patterns. In 32 % kidney we observed the classical arrangement ofhilar structures described in standard textbooks as renal vein, renal artery and pelvis. In 36% cases anteriortrunk of renal artery is the most anteriorly placed structure at the renal hilum. In 21% cases we observed anteriorand posterior tributaries of renal vein. The renal pelvis in between the divisions of renal artery and tributariesof renal vein was noted in 43% cases. We noticed the formation of the renal pelvis outside the hilum in 7% cases.Conclusion: Present study will help to provide better knowledge of disposition of renal hilar structures which willbe useful for the urological surgeons, radiologists and anatomists.

The application of renal sinus anatomy based tension-free reconstruction technique for robot-assisted nephron-sparing surgery of hilar tumors: a single center report and follow-up of 286 cases / 中华泌尿外科杂志

Objective To describe our renal sinus anatomy based tension-free reconstruction technique step by step and report perioperative data and long-term outcomes of patients undergoing robotassisted nephron-sparing surgery for hilar tumors.Methods From June 2013 to December 2016,data of 286 consecutive patients with hilar tumor who underwent RAPN in single center were retrospectively reviewed.There were 202 males and 84 females,aged (56.2 ± 9.2) years.The body mass index was (26.8 ± 3.5) kg/m2.The median diameter of tumor was 2.6 cm(0.8-6.0 cm),and R.E.N.A.L.score was 8.2 ± 1.8.The anatomy-based "Garland" technique specialized in protecting the large hilar vessels and minimizing the tension of trans/retroperitoneal defect suturing approach for anterior/posterior lip hilar tumor respectively.Patient's perioperative complications and long-term follow-up including renal function and oncological outcomes were analyzed.Results "Garland technique" was successfully applied in 284 patients,the warm ischemia time (WIT) was (18.2 ±4.1) min.Median estimated blood loss (EBL) for RAPN was 100 ml (range:10-600 ml).Median operative time was 120 min (range:60-230 min).No patient was converted to open surgery.Postoperative hospital stay was 4.0 d (range:2.0-9.0 d).Three patients (1.1％) had positive surgical margins.Of all the pathological results,260 cases (91.5％)were clear renal cell carcinoma,8 cases (2.8％)were chromophobe renal carcinoma,7 cases (2.5％)were papillary type renal cell carcinoma,5 cases(1.8％) were oncocytoma,3 cases (1.1％)were angiomyolipoma,one case (0.3％) was mucinous tubular and spindle cell carcinoma.Two patients underwent blood transfusion.Three patients(1.0％) had local recurrence.284 patients were alive at a median follow-up of 36 months (range:12-54 months).Conclusions "Garland technique" is safe and feasible for hilar tumor resection and reconstruction with less surgical complications.Large renal vessel injury was avoided and tension of wound closure was minimized.The trans/retroperitoneal approaches are capable for anterior/posterior hilar tumor.Patients with hilar tumor could benefit from robotic surgery with a well preserved renal function and good oncological outcomes.

Hallazgo anatomopatológico en un paciente adulto con una malformación renal congénita o anomalía de fusión / Pathological finding in an adult patient with a congenital renal malformation or fusion anomaly

Se describe el caso clínico de un paciente adulto con antecedentes de alcoholismo e hipertensión, quien falleció fuera de la institución hospitalaria y al realizarle la autopsia se encontró una ectopia renal cruzada con fusión, así como un único sistema excretor.

The case report of an adult patient with a history of alcoholism and hypertension who died outside of the hospital institution is described, and when carrying out the autopsy a cross renal ectopia with coalition, as well as only one excretory system were found.

Anatomical Study Of Arrangement Of Renal Hilar Structures In Indian Adult Human Cadavers.

Abstracts: Background: Knowledge of arrangement of renal hilar structure is essential in the era of minimally invasive surgery. Nephron sparing surgeries like partial nephrectomy by laparoscope is treatment of choice and in this surgery hilar dissection is one of the important steps. However, in literature very few reports are available regarding the different patterns of dispositions of renal hilar structures. Aim of present study was to evaluate the arrangement of renal hilar structures. Methodology: Present work was carried out on fifty seven pairs of morphological normal kidneys of embalmed cadavers. Renal hilum of each kidney was dissected carefully to see the arrangement of renal artery, vein and pelvis. Results: Arrangement of renal hilar structures showed great variation. We classified arrangement of renal hilar structures into ten different patterns. In 22.80 % kidney we observed the arrangement of hilar structures according to textbooks. We observed anterior and posterior tributaries of renal vein in 32.45% and in 41.22% kidneys pelvis was the posterior most relation. Conclusion: Present study will help to understand the better knowledge of the disposition of hilar structures for the urological surgeons, radiologist and anatomists.

Normal and variant anatomy of renal hilar structures and its clinical significance / Anatomía normal y variante de las estructuras hiliares renales y su significancia clínica

Advanced imaging techniques have resulted in increasing use of minimally invasive approaches for nephron sparing surgeries of kidney. Need for precise knowledge of normal and variant anatomy of vascular pedicle of kidney is thus justified. Ample literature is available on the variations in the intrarenal vascular pattern of the kidney, which are seen frequently. But the variation in arrangement of structures at the renal hilum has not gained much interest up till now. One hundred (51 right and 49 left) embalmed kidneys were utilized for the present study. Careful dissection of renal hilar structures was carried out to observe antero-posterior relationship of structures at the hilum of the kidney. In majority (73 percent), the arrangement was not according to the normal textbook description i.e. renal vein, renal artery and pelvis arranged antero-posteriorly. In 31 percent anterior division of renal artery was seen in front of renal vein at the hilum, whereas, in 50 percent cases the pelvis was not the posterior most relation. The variable patterns observed were classified into five types. In cases of renal hilar tumors laparoscopic partial nephrectomy is being done with a limited field of vision. Knowledge of these variations is useful for operating surgeons to identify and individually clamp the hilar structures, which is advantageous over en-bloc clamping.

Las técnicas avanzadas de imagen han permitido aumentar el uso de abordajes mínimamente invasivos para la cirugía conservadora del nefrón. Por esto, se justifica la necesidad de un conocimiento preciso de la anatomía normal y las variaciones anatómicas del pedículo vascular del riñón. Es amplia la literatura disponible sobre variaciones en el patrón vascular intrarrenal, lo que se observa con frecuencia. Sin embargo, hasta ahora, la variación en la disposición de las estructuras en el hilio renal no ha generado mucho interés. Se utilizaron 100 riñones fijados (51 derechos y 49 izquierdos) para el estudio. Una cuidadosa disección de las estructuras hiliares renales se llevó a cabo para observar la relación antero-posterior de las estructuras en el hilio del riñón. En la mayoría de los casos (73 por ciento), las características no estaba de acuerdo con la descripción normal de la vena renal, es decir, con la arteria renal y la pelvis renal dispuestos en sentido anteroposterior. Los patrones de las variables observadas fueron clasificadas en cinco tipos. En el 31 por ciento de los casos la división anterior de la arteria renal estaba anterior a la vena renal en el hilio, mientras que, en el 50 por ciento de los casos, la pelvis no estaba posterior. En los casos de tumores renales hiliares la nefrectomía parcial laparoscópica se realiza con un limitado campo de visión. El conocimiento de estas variaciones es útil para un adecuado desempeño de los cirujanos al identificar y separar individualmente las estructuras hiliares, que es una ventaja sobre la separación en bloque.

Case Report on Horseshoe Kidney / 체질인류학회지

The authors dissected and examined a horseshoe kidney from the cadaver of a 54-year-old Korean female. The results were as follows. Other congenital anomalies or complications were not found, and no renal stones showed on plain radiography of the horseshoe kidney. The horseshoe kidney was located in the area between the 12 th thoracic vertebra and the 4th lumbar vertebra, with the superior extremity of the left kidney 10mm more inferior than that of the right. The isthmus connecting the bilateral kidneys was located at the level of the 3rd lumbar vertebra. The size of the kidney was 102mm × 52mm × 44mm (right) and 108mm × 62mm × 34mm (left), and the superoinferior and anteroposterior lengths of isthmus were 22mm and 10mm, respectively. The abdominal aorta and inferior vena cava passed posteriorly to the isthmus, with the inferior mesenteric artery and lumbar splanchnic nerve passing anteriorly. Some grooves were found on the anterior surface of the bilateral kidney. The hilum of the right kidney faced the anteromedial direction and that of the left kidney faced the anterolateral direction. At the hilar plane, the right renal arteries and veins passed anteriorly and posteriorly to the renal pelvis ; the left renal arteries passed posteriorly to the renal pelvis, with the left renal veins passing anteriorly and posteriorly. Three branches of the right renal arteries passed renal hilum, while two branches did not, and two branches of the left renal arteries passed renal hilum, while six branches did not. The two arteries arising from the aortic bifurcation were distributed to the isthmus. The number of renal veins passing the renal hilum were three in the right, and two in the left. The right and left ovarian veins drained to the renal veins. There were 12 minor calyces distributed normally in the right kidney, 13 minor calyces distributed radially in the left kidney, and 3 minor calyces in the isthmus, composed of parenchyme. The left portion of the horseshoe kidney was concluded to have developed poorly, on the basis of incomplete ascension and abnormal rotation during development, the imperfect configuration of the renal shape, and the abnormal distribution of the renal vessels and renal calyces.

Accessory Renal Arteries Found during Dissection / 체질인류학회지

Accessory renal artery (ARA) is a kind of developmental anomaly in renal artery. It is important in respect to clinical medicine, for example primary hypertension, renovascular disease, inferior vena caval obstruction, ureteral obstruction, occurrence of other vascular anomalies such as accessory renal veins, surgical importance and renal transplantation. However, up to few research of ARA was reported in dissection of cadavers. In our dissecting theater, 12 accessory renal arteries for 10 cadavers were found during dissection the 22 cadavers from 1995 to 1996. 1. Two cases were bilateral and 8 cases were unilateral accessory renal arteries. 2. Seven cases were left and 5 cases were right accessory renal arteries. 3. Two cases originated at the abdominal aorta between celiac trunk and superior mesenteric artery, 7 cases originated between superior mesenteric artery and inferior mesenteric artery, and 3 cases originated below inferior mesenteric artery. 4. Seven cases have no branches during their courses, 4 cases have 3 branches, and a case has 2 branches. 5. Seven cases entered into renal parenchyma through renal hilum, 5 cases entered into apical and arterosuperior segments, and 6 cases entered into inferior segment.