Ureteropelvic junction obstruction (UPJ) due to congenital crossing of the renal vessels (CRV): Comparison of the pre- and postoperative features of UPJO with and without CRV.

We evaluated the differences in demographic characteristics of patients with and without underlying crossing renal vessels (CRVs) operated for unilateral symptomatic ureteropelvic junction obstruction (UPJO). We identified the features of patients who had undergone open, laparoscopic and robotically assisted laparoscopic pyeloplasty at our institution from July 2000 to January 2021. The ratio of renal parenchymal thickness (RPT; ratio between the kidney with UPJO and the healthy kidney), pelvic diameter and kidney functions were recorded. A total of 641 patients were operated for UPJO; 448 were male (69.8%) and 193 (30.1%) were female; 257 had right-side (40%) and 384 (60%) left-side disease. Fifty-eight patients (9%) were found to have CRV (operated on to treat CRV). The age at diagnosis was 6.51 ± 5.09 years in the CRV (+) group and 1.82 ± 1.37 years in the CRV (-) (p < 0.001). The age at surgery was 8.00 ± 4.71 and 4.27 ± 3.54 years, respectively (p < 0.001). At the time of diagnosis, the RPT measurement was significantly better in CRV (+) compared to CRV (-) group (0.71 ± 0.2 vs. 0.64 ± 0.23, p = 0.043) and initial renal functions were 45.53 ± 8.99% and 42.99 ± 11.65% in CRV (+) and (-) groups respectively. At the time of surgery, the RPTs were 0.60 ± 0.24 and 0.63 ± 0.21 in CRV (+) and (-) groups and these values were also correlated with split renal functions (36.28 ± 15.81% and 41.80 ± 14.26%, respectively). Renal functions were significantly decreased in CRV (+) group (p = 0.027). Significant parenchymal improvements were noted during the first postoperative year. The RPTs were 0.71 ± 0.2 and 0.77 ± 0.19 in the CRV (+) and CRV (-) groups, respectively (p = 0.27) in that time; the improvements continued to increase to postoperative third year (0.74 ± 0.20 and 0.78 ± 0.19 respectively; p = 0.939). In patients with CRVs, renal functions seemed to be preserved in the early stages, however it should be kept in mind that sudden obstruction and loss of kidney function might develop in the follow up period.

Isolated right renal hilum mass with severe adhesion to the renal vessels and Vena Cava in a patient with single functioning kidney: A case report.

We report a case of a single kidney patient with an isolated renal hilum mass which is accompanied by severe vascular involvement. A 56-year-old woman with right flank pain was referred to our center. Ultrasound and CT scan showed a hypoechoic and solid mass in the right kidney pedicle. The renal mass biopsy showed a clear cell carcinoma. The patient was scheduled for surgery and the isolated mass was removed. To the best of our knowledge, this is the first case of renal hilum mass of Renal Cell Carcinoma (RCC) origin that had no connection to kidney parenchyma.

Artéria renal tripla em porco-espinho (Sphiggurus villosus): relato de caso / Triple renal artery in porcupine (Sphiggurus villosus): case report

O interesse pelo estudo de animais silvestres vem crescendo consideravelmente nos últimos anos, seja em decorrência do risco de extinção ou visando o controle de doenças, especialmente as zoonoses. A ordem Rodentia apresenta o maior número de espécies da classe Mammalia. Apesar de ampla distribuição e importância, dados sobre sua anatomia vascular renal são escassos na literatura. O objetivo deste artigo é relatar o aparecimento de variação numérica na artéria renal esquerda em Sphiggurusvillosus com enfoque nas possibilidades de implicações clínico-cirúrgicas, como, anastomoses cirúrgicas, estudos imaginológicos, nefrectomias e planejamento pré-operatório para redução de riscos e complicações como hemorragia. O cadáver foi devidamente formolizado no Laboratório de Ensino e Pesquisa em Morfologia de Animais Domésticos e Selvagens e posteriormente dissecado. O rim esquerdo apresentou três artérias renais, uma cranial, uma intermediaria e outra caudal, ambas posicionadas em nível de L2 emergindo de forma impar lateralmente da aorta abdominal. A primeira artéria, mais cranial, apresentou 10,52 mm de comprimento e se dirigiu diretamente para o hilo renal, emitindo ramo para adrenal, diafragma e musculatura sublombar. A segunda artéria, intermediária, mediu 7,77 mm, emitiu ramo cranial e caudal para o hilo renal e ramo ureteral. A terceira artéria, caudal, mediu 10,11 mm e se dirigiu para o hilo renal. A veia renal esquerda era única e apresentou 9,25 mm de comprimento, posicionada em nível de L1. Este é o primeiro relato de artéria renal tripla em mamífero silvestre.

Interest in the study of wild animals has grown considerably in recent years, either due to the risk of extinction or to control diseases, especially zoonoses. The order Rodentia has the largest number of species in the Mammalia class. Despite its wide distribution and importance, data on its renal vascular anatomy are scarce in the literature. The aim of this paper is to report the appearance of numerical variation in the left renal artery in porcupine focusing on the possibilities of clinical and surgical implications, such as surgical anastomoses, imaging studies, nephrectomies and preoperative planning to reduce risks and complications such as bleeding. The animal was duly formalized in the Laboratory of Teaching and Research in Morphology of Domestic and Wild Animals and subsequently dissected. The left kidney had three renal arteries, one cranial, one intermediate, and one caudal, both positioned at L2 level, emerging unevenly laterally from the abdominal aorta. The first more cranial artery was 10.52 mm long and directed directly into the renal hilum, emitting a branch to the adrenal, diaphragm and sub lumbar muscles. The second intermediate artery measured 7.77 mm, emitting a cranial and caudal branch to the renal hilum and ureteral branch. The third caudal artery measured 10.11 mm and headed straight for the renal hilum. The left renal vein was unique, measured 9.25 mm long, and positioned at L1 level. This is the first report of triple renal artery in wild mammals.

Artéria renal tripla em porco-espinho (Sphiggurus villosus): relato de caso / Triple renal artery in porcupine (Sphiggurus villosus): case report

O interesse pelo estudo de animais silvestres vem crescendo consideravelmente nos últimos anos, seja em decorrência do riscode extinção ou visando o controle de doenças, especialmente as zoonoses. A ordem Rodentia apresenta o maior número deespécies da classe Mammalia. Apesar de ampla distribuição e importância, dados sobre sua anatomia vascular renal são escassosna literatura. O objetivo deste artigo é relatar o aparecimento de variação numérica na artéria renal esquerda em Sphiggurusvillosus com enfoque nas possibilidades de implicações clínico-cirúrgicas, como, anastomoses cirúrgicas, estudos imaginológicos,nefrectomias e planejamento pré-operatório para redução de riscos e complicações como hemorragia. O cadáver foi devidamenteformolizado no Laboratório de Ensino e Pesquisa em Morfologia de Animais Domésticos e Selvagens e posteriormente dissecado.O rim esquerdo apresentou três artérias renais, uma cranial, uma intermediaria e outra caudal, ambas posicionadas em nível de L2emergindo de forma impar lateralmente da aorta abdominal. A primeira artéria, mais cranial, apresentou 10,52 mm de comprimentoe se dirigiu diretamente para o hilo renal, emitindo ramo para adrenal, diafragma e musculatura sublombar. A segunda artéria,intermediária, mediu 7,77 mm, emitiu ramo cranial e caudal para o hilo renal e ramo ureteral. A terceira artéria, caudal, mediu10,11 mm e se dirigiu para o hilo renal. A veia renal esquerda era única e apresentou 9,25 mm de comprimento, posicionada emnível de L1. Este é o primeiro relato de artéria renal tripla em mamífero silvestre.

Interest in the study of wild animals has grown considerably in recent years, either due to the risk of extinction or to control diseases,especially zoonoses. The order Rodentia has the largest number of species in the Mammalia class. Despite its wide distributionand importance, data on its renal vascular anatomy are scarce in the literature. The aim of this paper is to report the appearanceof numerical variation in the left renal artery in porcupine focusing on the possibilities of clinical and surgical implications, suchas surgical anastomoses, imaging studies, nephrectomies and preoperative planning to reduce risks and complications such asbleeding. The animal was duly formalized in the Laboratory of Teaching and Research in Morphology of Domestic and Wild Animalsand subsequently dissected. The left kidney had three renal arteries, one cranial, one intermediate, and one caudal, both positionedat L2 level, emerging unevenly laterally from the abdominal aorta. The first more cranial artery was 10.52 mm long and directeddirectly into the renal hilum, emitting a branch to the adrenal, diaphragm and sub lumbar muscles. The second intermediate arterymeasured 7.77 mm, emitting a cranial and caudal branch to the renal hilum and ureteral branch. The third caudal artery measured10.11 mm and headed straight for the renal hilum. The left renal vein was unique, measured 9.25 mm long, and positioned at L1level. This is the first report of triple renal artery in wild mammals.

Para-aortic lymphadenectomy below inferior mesenteric artery versus renal vessels in stage IIIC epithelial ovarian cancer: A comparison of surgical outcomes.

OBJECTIVE: To compare the surgical outcomes of para-aortic lymphadenectomy up to the level of inferior mesenteric artery (IMA) and renal vessels in women with stage IIIC epithelial ovarian cancer after primary optimal cytoreductive surgery. METHODS: In a retrospective study at Peking University People's Hospital, Beijing, China, undertaken between January 1, 2001, and December 31, 2015, patients were classified into two groups based on the level of the para-aortic lymphadenectomy at either IMA (group A) or renal vessels (group B). Progression-free survival (PFS) and overall survival were assessed. RESULTS: The study involved 102 women (56 in group A and 46 in group B). The two groups were comparable regarding clinical characteristics, and there were no statistically significant differences in perioperative variables between the groups. 15.2% of patients (7/46) had metastases at renal vessels level without metastases below IMA. Median PFS in group B was longer than group A (41 months vs 23 months, P=0.041) and 5-year survival rate was greater in group B compared to group A (74.6% vs 48.2%, P=0.003). Median overall survival was longer in group B compared to group A (not reached vs 55 months, P=0.03). CONCLUSION: Para-aortic lymphadenectomy at the level of renal vessels was safe and could improve the prognosis of patients with advanced ovarian cancer who completed optimal cytoreduction.

There are more anatomical variants in heaven and earth, Horatio, than are dreamt of in our philosophy: the precaval left renal artery.

AIM: To describe the CT findings in eight patients with left-sided inferior vena cava (IVC) in whom the left renal artery presented a precaval course (pLRA). MATERIALS AND METHODS: We searched the teaching files of six radiology departments for patients with pLRAs. Eight patients were found, and the available imaging studies and clinical histories were reviewed. Associated vascular and renal anomalies were noted. RESULTS: No patient had been examined for problems related to the vascular anomaly found. Four had a double IVC and two a solitary left IVC; in all, the left-sided IVCs had hemiazygos continuation. One patient had situs viscerum inversus. In one case, there was a left kidney in left iliac fossa. CONCLUSION: Although rare and probably overlooked, a pLRAs can be encountered in patients with situs viscerum inversus or presenting a left-sided IVC with hemiazygos continuation. These vessels can cause technical problems during surgery at the left renal hilum and should be specifically searched for in patients with vascular anomalies.

Circumaortic left renal vein (circumaortic renal collar) associated with the presence of vascular anomalies: a case series and review of literature.

Renal vessels exhibit a high degree of anatomical variations in terms of their number, level of origin, diameter and topographical relationships. In particular, it applies to the left renal vein which can take retroaortic or even circumaortic placement. Anatomical variations of the left renal vein may be of great clinical significance, particularly in the case of renal transplantation, retroperitoneal surgery as well as vascular or diagnostic procedures. Thus, the aim of this report was to present a complete anatomical description of two cases of the circumaortic left renal vein (CLRV; circumaortic renal collar) co-existing with the presence of various vascular anomalies. In the first case, the circumaortic renal collar was connected via a large anastomosis with the hemiazygos vein and was associated with the presence of the supernumerary left renal artery located below the main left renal artery. In the second case, the circumaortic renal collar was accompanied by the renal artery dividing close to its origin. Moreover, in the latter case, the fusiform aneurysm of the abdominal aorta was observed. In both cases, the CLRV began as a single and short trunk. On its further course, the initial segment of the CLRV was divided into two limbs - anterior (anterior left renal vein) and posterior (posterior left renal vein). Both anterior and posterior limb of the CLRV opened into the inferior vena cava.

Incidence of variations in human cadaveric renal vessels.

BACKGROUND: Awareness of discrepancies of renal vasculature is crucial for some medical procedures. The present study investigated origin and course of aberrant and accessory renal vessels and any associated variations. MATERIALS AND METHODS: Renal blood vessels of 63 cadavers were examined. Number of renal veins and arteries, arrangement, location where the vasculature attached to the kidneys, and presence of variations were recorded. Incidence of renal vasculature variations was determined, and associations were tested with age at death, sex, and cause of death and whether variations were more common on a specific side. RESULTS: Variations were found in 7 (11%; 95% confidence interval [CI] 5-22%) cadavers. For renal veins, double, triple, and quadruple veins unilaterally (5; 8%) and veins that drained the superior pole (1; 2%) or inferior pole only (5; 8%) were found. For renal arteries, double and triple arteries unilaterally (3; 5%) and arteries attached to the superior pole only (1; 2%) or inferior pole only (2; 3%) were found. Other variations (polycystic kidney, variations in the common iliac or gonadal veins) were observed. Only renal failure as a cause of death was different between those with or without variations (4/7 [57%] vs. 1/56 [2%]; p < 0.001). CONCLUSIONS: The present study found many variations in renal vasculature. Awareness of such variations may be useful for physicians concerned with this region.

Four-dimensional phase-contrast vastly undersampled isotropic projection reconstruction (4D PC-VIPR) MR evaluation of the renal arteries in transplant recipients: Preliminary results.

PURPOSE: To assess the performance of four-dimensional phase-contrast vastly undersampled isotropic projection reconstruction (4D PC-VIPR) at 3.0T in depicting intrarenal arteries compared with computed tomography angiography (CTA), and its correlation with arterial flowmetry in comparison with Doppler ultrasonography (DUS). MATERIALS AND METHODS: In our prospective single-arm study, subjects were 25 patients who underwent renal transplant-related surgery at our hospital between July 2011 and June 2015. In the morphological study, depictions of renal artery branches delineated by magnetic resonance angiography (MRA)/4D PC-VIPR without gadolinium contrast agent were compared in seven living transplant recipients with the same kidney delineated by CTA in seven living transplant donors. In the flowmetric study, flow velocities in the renal (main stem), segmental, and interlobar arteries during systole and diastole were measured in 12 recipients using noncontrast MRA/4D PC-VIPR, and were compared with those obtained from DUS. RESULTS: Concerning MRA, average confidence levels of delineation rated by six observers for secondary to third level renal artery branches were 82.9-100% and for the fourth to fifth branches were 60.8-89.7% (average kappa value of 0.588 [95% confidence interval: 0.522-0.653]). Total flow velocities measured using 4D PC-VIPR and DUS demonstrated significant correlations during both systole and diastole with acceptable bias (r = 0.902; P < 0.001 in systole and r = 0.734; P < 0.001 in diastole). CONCLUSION: 4D PC-VIPR was useful in generating both morphological and hemodynamic information for evaluation of transplant intrarenal arteries without the need for contrast media. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:595-603.

Effect of response to phenylephrine-mediatedsignal pathway in renal arteries of offspring rats inducedby maternal high-salt diet / 中国药理学通报

Aim To study the effect of high salt diet during pregnancy on the development of renal vessels in offspring rats and its mechanism.Methods Natural pregnant Sprague-Dawley rats were randomly divided into high-salt group and control group.The pregnant rats in the high-salt group were given high-salt diet of 8% NaCl content , while the control group normal diet with 1% NaCl content.In both groups, pregnant rats were given normal drinking water.After delivery, all mothers returned to normal diet and all neonatal rats were breast-fed until one month old.The adult male off springs were used as experimental animals.The vessel tone of renal interlobar arteries and electrophysiological behavior of single vascular smooth muscle cells (VSMCs) were detected respectively.Results The contractile response of renal arteries to phenylephrine(Phe) in high-salt group was stronger than that in the control group(P0.05).Conclusions High-salt diet during pregnancy could increase the sensitivity of renal interlobar arterial contractile response to Phe in adult male offsprings, which is associated with PKC-mediated BK channels pathway.Maternal high-salt diet during pregnancy may increase the risk of renal vascular diseases in adult offsprings.

Supernumerary renal vessels: analysis of frequency and configuration in 996 computed tomography studies.

BACKGROUND: Number, course and division pattern of renal vessels is highly variable. Variant renal vasculature is of high interest in nephrectomy for the renal transplantations, both in deceased and living donors. The purpose of the study was to analyse the frequency of supernumerary renal vessels in a large cohort of patients undergoing the multiphase abdominopelvic computed tomography (CT), as well as analyse the possible patterns of coexisting supernumerary arteries in veins. MATERIALS AND METHODS: A retrospective analysis of abdominopelvic CT studies within 1 year period was performed. In each study, number of renal arteries and veins was recorded. Course of left renal vein was classified into normal, retro- or periaortic. For statistical analysis of normal distribution data, t-Student test was used. Chi-square test was used for frequency of variant vessel distribution. Pearson correlation coefficient was used for the analysis of coexistence of supernumerary vessels. RESULTS: 996 patients were included in the analysis, male to female ratio: 481:515 (48%:52%). Mean age was 57.9 ± 14.7 years. Single renal arteries were observed in 73% of cases, while single renal veins in 95%. Circumaortic or retroaortic courses of left renal veins were observed in 10% of cases. Number of renal vessels has been compared in patients with and without supernumerary vessels. In patients with supernumerary left renal artery, significantly more right renal vessels were observed. In patients with supernumerary right renal vein, mean number of all remaining vessels was significantly higher. CONCLUSIONS: Supernumerary renal vessels are a frequent finding in abdominal CT studies. Finding a supernumerary vessel should increase awareness of possible other supernumerary renal vessels.

[Renal hemodynamic in hydronephrosis concurrent with hepatobiliary system disorders, its dynamics in the course of treatment].

This article examines measurements of renal vascular ultrasound in 85 patients with hydronephrosis concurrent with disorders of the gallbladder and biliary tract, depending on severity and dynamics during treatment. The estimation of blood flow changes depending on applied renoprotective and hepatoprotective therapy is provided.

In vivo regeneration of renal vessels post whole decellularized kidneys transplantation.

Nearly 50 million patients in China live with end-stage renal disease (ESRD), and only about 4000 patients may receive kidney transplantation. The purpose of this study was to investigate regeneration of renal vessels post whole decellularized kidneys transplantation in vivo. We decellularized kidneys of donor rats by perfusing a detergent through the abdominal aorta, yielding feasible extracellular matrix, confirmed for acellularity before transplantation. Based on the concept of using the body as a bioreactor, we orthotopically transplanted the kidney and ureter scaffolds in recipient rats, and found the regeneration of vessels including artery and vein in the renal sinus following a spontaneous recanalization. Although the findings only represent an initial step toward the ultimate goal of the generation of fully functional kidneys in vivo, these findings suggest that the body itself, as the bioreactor, is a viable strategy for kidney regeneration.

Multiple anatomical variations of the renal vessels associated with malrotated and unrotated kidneys: a case report.

Variations in the number of renal vessels represent the most common anatomical variations in renal vasculature. Here, a rare case of multiple anatomical variations of renal vessels was found in a 70-year-old female cadaveric dissection. Three renal arteries and two renal veins were observed to supply the right kidney, which was malrotated and ectopic; on the left side, the kidney was unrotated and presented two renal arteries and normal renal vein. In particular, we paid attention to the pattern of the three renal arteries that originated from the lateral side of the aorta and passed anteriorly to the inferior vena cava. A rare case of ovarian vein that drained into the right renal vein was also reported. The descriptions of these multiple anatomical variations should be considered by clinicians for performing correct surgical and radiological procedures.

Renal retransplantation after kidney and pancreas transplantation using the renal vessels of the failed allograft: pitfalls and pearls.

Renal retransplantation after a failed prior kidney and pancreas transplant is being increasingly performed. In these complex cases, both iliac fossae have been used for prior transplants, and the placement of the new allograft can be problematic. We describe our experience with an alternative technique for renal retransplantation (RRTx) in the setting of severe bilateral aortoiliac atherosclerosis or scarring and fibrosis on the iliac vessels. Nephrectomy of the failed allograft is performed, and the renal vessels of the failed allograft (RVFA) are preserved. The new kidney is implanted on RVFA at the same operative time. This technique was attempted and successfully accomplished in a total of six patients (mean operative time = 240 ± 63 min). One postoperative complication occurred: poor arterial inflow to the allograft, being corrected reoperatively. Hospitalizations ranged from five to eight d. Five of the six patients were alive with a functioning allograft at last follow-up (a single graft failure occurred 21 months postoperatively in the setting of post-transplant lymphoproliferative disease that also led to patient death). Renal vessels of the failed allograft seem to be suitable alternative vascular conduits for renal retransplantation after prior kidney and pancreas transplants.

Efficacy of laparoscopic nephron-sparing surgery without renal wound suturing / 中华泌尿外科杂志

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-sparing surgery without renal wound suturing.Methods From December 2012 to February 2014,9 patients (4 male,5 female) with renal tumor underwent laparoscopic nephron-sparing surgery without suturing in our hospital.The mean age in those patients was 56 years (range 42-72 years).The mass size ranged from 1.1to 3.8 cm (mean 2.4 cm).The location of tumor included 2 in left kidney,7 in right kidney.Meanwhile,6 tumors were found in the middle part of kidney,2 tumors were demonstrated in the lower part of kidney,and 1 tumor located in the upper part of kidney.The imaging examination confirmed that all tumors protruded the renal surface and infiltrated into the renal parenchyma about 0.1-1.2 cm,which could be defined as the peripheral renal tumor without the invasion of collective system.The retroperitoneal approach was used in all patients with 3 trocars.During the operation,the renal artery was exposed and fats surrounding or on the surface of the tumor were resected.The renal artery was occluded.Tumor excision was then performed using scissors.An incision was made at the point 0.5 cm away from the margin of the tumor,extending deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.Then,the clamping of the renal artery was removed and the retroperitoneal pressure was reduced in order to check the site of bleeding.If the bleeding occurred severely,the kidney wound was sutured with 2-0 absorbable sutures.Otherwise,the coagulative glue was sprayed on the wound surface.Results In all the patients,the procedures were done without conversion to open surgeries.The renal wound suturing appeared in one case because the tumor infiltrated into the deep of the kidney and the bleeding could not be completely controlled by bipolar diathermy.Eight of 9 cases were successfully performed without suturing.The mean time of renal artery occlusion was 8 min (range 3-18 min).In our patients,the mean operation time was 120 min (90-180 min),and the mean blood loss was 60 ml (10-200 ml).None of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 7 days (5-9 days).No complications,such as urine leakage,bleeding occurred after the operation.All the patients were followed up with no recurrence of tumor.Conclusions Laparoscopic nephron-sparing surgery without renal wound suturing is feasible and safe for patients with the small and the depth of infiltration less than 0.5 cm tumor in the kidney.

Accessory renal vessels.

Knowledge of the variations of the renal artery has grown in importance with increasing of renal transplants, vascular reconstructions and various surgical and radiologic techniques performing in recent years. We report the presence of unilateral doubled renal vessels, discovered on routine dissection of a male cadaver, on the right side; additional renal artery originated from the abdominal aorta. In addition the right suprarenal gland received arteries from right renal and inferior phrenic arteries only. The right inferior phrenic originated from the right renal artery.

Multidetector row computed tomography evaluation of the micropig kidney as a potential renal donor

Multidetector row computed tomography (MDCT) provides anatomical information about the kidney and other internal organs. Presently, the suitability of 64-channel MDCT to assess the kidney of healthy micropigs was evaluated. Morphological evaluations of the kidney and the major renal vessels of six healthy micropigs were carried out using MDCT, recording kidney volume and the diameter and length of renal arteries and veins. The mean diameters and lengths of the renal artery were 0.44 +/- 0.05 and 4.51 +/- 0.55 cm on the right side and 0.46 +/- 0.06 and 3.36 +/- 0.27 cm on the left side, respectively. The mean diameters and lengths of the renal vein were 1.44 +/- 0.52 and 4.22 +/- 1.29 cm on the right side and 1.38 +/- 0.17 and 5.15 +/- 0.87 cm on the left side, respectively. The mean volume of the right kidney was 79.3 +/- 14.5 mL and of the left kidney was 78.0 +/- 13.9 mL. The data presented in this study suggest that the MDCT offers a noninvasive, rapid, and accurate method for the evaluation of the renal anatomy in living kidney donors. It also provides sufficient information about extra-renal anatomy important for donor surgery and determination of organ suitability.

Venous communication between the right and left kidneys: a rare anatomic variation / Comunicación venosa entre los riñones derecho e izquierdo: una rara variación anatómica

Renal vascular anatomic variations, especially of the renal arteries, have been observed in about 20-30 percent of cases, which are very often verified in the left antimere. These variations showed two or three renal arteries stemming directly from the aorta. These anatomic variations have been considered extremely important risk factors in surgical proceedings by different authors. The dissection of a cadaver showed an uncommon venous feature in addition to renal artery variation, specially, in the left antimere. A direct venous communication between left and right kidneys was verified without there being any relation to the inferior cava vein or common iliac veins. Thus, the knowledge of blood vessel anatomic variation is an important element to improve surgical techniques as well as to provide precise analyses of urological and radiological proceedings in different renal diseases. Specially, taking into consideration that hard traction of the renal pedicle could rupture the vessels, leading to lethal hemorrhaging.

Se han observado variaciones anatómicas vasculares renales, especialmente de las arterias renales, en una frecuencia alrededor del 20 a 30 por ciento de los casos, cuya incidencia se verifica a menudo en el antímero izquierdo. En estas variaciones, de acuerdo con lo que se notó, dos o tres arterias renales provenían directamente de la aorta. Distintos autores han considerado que estas variaciones anatómicas son factores de riesgo extremadamente importantes en los procedimientos quirúrgicos. En esta investigación, por medio de la disección de un cadáver, se observó una característica venosa rara, además de la variación de la arteria renal, especialmente en el antímero izquierdo. Se verificó una comunicación venosa directa entre los ríñones izquierdo y derecho, pese al hecho que no sea común cualquier relación con la vena cava inferior o las venas ilíacas comunes. Así, el conocimiento de la variación anatómica del vaso sanguíneo es un elemento importante para implementar técnicas quirúrgicas, así como proporcionar análisis exactos de procedimientos urológicos y radiológicos en diversas enfermedades renales, pues se debe considerar además que la tracción dura del pedículo renal podría romper los vasos y ocasionar una hemorragia mortal.

Laparoscopic Nephron-Sparing Surgery without Hilar Clamping or with Temporary Hilar Control / 中国微创外科杂志

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-spring surgery for renal tumor.Methods From September 2004 to November 2006,29 patients with renal tumor underwent laparoscopic nephron-sparing surgery without hilar clamping or with temporary hilar control in our hospital.The retroperitoneal approach was used in 25 patients with 4 trocars.During the operation,the renal artery was exposed and then the vessel bundles were pulled out of the abdominal cavity through one of the trocars,passing by the renal artery without clamping it.Afterwards,fatty cysts surrounding or on the surface of the tumor were resected.Tumor excision was then performed using ultrasonic shears.An incision was made at the point 0.5 cm away from the margin of the tumor,and was extended deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.The renal artery was occluded when necessary so that the tumor could be cut within a limited time duration.And the occlusion could be re-opened after controlling the bleeding.After the procedure,the renal incision was compressed with gauze,sutured with 2-0 absorbable sutures,and covered with fibrin sealant.In the other 4 patients,trans-peritoneal approach was used.The ureter was exposed near the lower pole of the kidney and separated towards the renal hilum to find out the renal artery.The following steps were similar to the above mentioned. Results In all the patients,the procedures were done without conversion to open surgeries.In this series,20 operations were completed without clamping the renal artery;and in the other 9,the mean time of renal artery occlusion was 14 min(5-20 min).In our patients,the mean operation time was 165 min(105-240 min),and the mean blood loss was 90 ml(20-800 ml).Two of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 9 d(7-17 d).No complications,such as urine leakage,occurred after the operation.Eighteen patients were followed up for a mean of 9 months(1-26 month),no recurrence of tumor was found.Conclusion Laparoscopic nephron-sparing surgery without hilar clamping or with contemporary hilar control is feasible and safe for patients with peripheral renal tumor not involving the renal collecting system.