The Change in the Renal Pelvis Anterior-Posterior Diameter Between Prevoiding and Postvoiding Status, and Its Correlation With Vesicoureteral Reflux.

In this study, our aim was to evaluate the significance of the change in renal pelvis anterior-posterior diameter (RPAPD) before and after micturition between vesicoureteral reflux (VUR)-positive and -negative patients to whom had voiding cystourethrography (VCUG) was performed.In this study, 69 children, age ranging from 0 to 12 years, were included. Before the VCUG imaging, the RPAPD was measured first with a full bladder and then after urination via ultrasound (US). The differences between in RPAPD measurements were noted and values compared made among VUR-positive and -negative children. Data distribution was inhomogeneous, and the Wilcoxon Sign Rank test was utilized instead of Student t test. There was no statistically significant difference in prevoiding and postvoiding RPAPD in VUR (+) and VUR (-) patients (P = 0.672). There was no statistically significant relation between VUR and the presence of hydronephrosis (P = 0.126). Vesicoureteral reflux is more common in patients with urinary tract infections (UTI) (P = 0.001). There was no statistically significant relationship between prevoiding and postvoiding RPAPD change and VUR diagnosis (P = 0,164).Ultrasound is the modality of choice for urinary system evaluation. Diagnosis of hydronephrosis via US is not sufficient in predicting VUR; however, indirect findings may reveal the diagnosis. A decrease in RPAPD in postvoiding US evaluation may not rule out the VUR diagnosis for this reason further imaging modalities, such as VCUG, should be taken into consideration for the patients with clinical suspicion.

Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones: outcomes with a systematic review of literature.

Controversies exist on the influence of lower pole anatomy (infundibular pelvic angle, IPA; infundibular length, IL; and infundibular width, IW) for success and outcomes related to the treatment of stones in the lower pole. We wanted to look at the role of lower pole anatomy to study clinical outcomes in patients treated for isolated lower pole stones (LPS) using retrograde intra renal surgery (RIRS), and also perform a review to look at the published literature on the influence of pelvicalyceal anatomy on success with RIRS. Data were prospectively collected (June 2013-June 2016) for all patients who underwent RIRS for LPS, and the imaging was then retrospectively reviewed to calculate the IPA, IL and IW using the Elbahnasy method. A systematic review was also conducted for all English language articles between January 2000 and April 2018, reporting on the impact of pelvicaliceal anatomy on RIRS. A total of 108 patients with LPS were included with a male to female ratio of 2:3 and a mean age of 54.7 years. The mean lower pole stone size was 9.3 mm (range 3-29 mm) and 102/108 (94.4%) patients were stone free (SF) at the end of their procedure. While steep IPA (< 30°), operative time duration and larger stone size were significant predictors of failure, the placement of ureteric access sheath, IW and IL did not influence treatment outcomes. Six studies (460 patients) met the inclusion criteria for our review. The IPA, IW, IL for failure ranged from 26° to 38°, 5.5-7 mm and 24-34 mm, respectively. The SFR ranged from 78 to 88% with a metaanalysis showing IPA as the most important predictor of treatment outcomes for LPS. Infundibular pelvic angle seems to be the most important predictor for the treatment of LPS using RIRS. Pelvicalyceal anatomy in conjunction with stone size and hardness seem to dictate the success, and decisions on the type of surgical interventions should reflect this.

Proposal for a Simple Anatomical Classification of the Pelvicaliceal System for Endoscopic Surgery.

We herein propose a nomenclature for renal calices and anatomical classification of the renal pelvis for endoscopic surgery. We prospectively collected data on a total of 270 patients (540 kidneys) who underwent CT-urography. We then constructed three-dimensional images of the renal pelvis and examined their morphologic classification. Forty-eight kidneys were excluded from this study because of severe hydronephrosis or large renal cysts. The remaining 492 kidneys were included. We systematically categorized each minor calix into five levels: top, upper, middle, lower, and bottom. The upper, middle, and lower calices were typically found in pairs: anterior and posterior. The most common total number of minor calices was eight (51%), followed by seven (30%). We also classified the form of the pelvis into type I: single pelvis (58%) and type II: divided pelvis (42%), according to the branch patterns of the renal pelvis. In type II, the renal pelvis is always bifurcated into the upper branch (top and upper) and lower branch (middle, lower, and bottom). Type I was subclassified into three types: type Ia (43%), the standard type; type Ib (4%), with a wide pelvis; and type Ic (11%), with a narrow pelvis. This anatomical classification can divide the renal pelvis into two major types (subdivided into four types) and name each minor calix. This simple classification enables to share common intrarenal information, thus leading to the development of concrete treatment strategies.

Pelvi-ureteric junction obstruction related to crossing vessels: vascular anatomic variations and implication for surgical approaches.

Pelvi-ureteric junction obstruction corresponds to an impairment of urinary transport that can lead to renal dysfunction if not treated. Several mechanisms can cause the obstruction of the ureter including intrinsic factors or extrinsic factors such as the presence of crossing vessels. The treatment of the disease relies on surgical approaches, pyeloplasty being the standard reference. The technique consists in removing the pathologic ureteric segment and renal pelvis and transposing associated crossing vessels if present. The vascular anatomy of the pelvi-ureteric junction is complex and varies among individuals, and this can impact on the disease development and its surgical treatment. In this review, we summarize current knowledge on vascular anatomic variations in the pelvi-ureteric junction. Based on anatomic characteristics, we discuss implications for surgical approaches during pyeloplasty and vessel transposition.

The Association of a Number of Anatomical Factors with the Success of Retrograde Intrarenal Surgery in Lower Calyceal Stones.

PURPOSE: To determine anatomical factors affecting Retrograde Intrarenal Surgery (RIRS) success in the treatment of renal lower calyx stones. MATERIALS AND METHODS: The results of patients were evaluated retrospectively. The patients who have preoperative intravenous urography (IVU) and computed tomography (CT) were divided into two groups as successful (S)(N=103) and unsuccessful(U) (N=29). The anatomic characteristics such as infundibulopelvic angle (IPA), infundibular length (IL), infundibular width (IW) and pelvicaliceal height (PCH) values were compared among two groups. RESULTS: Mean patient age was 47±13.6 years in group S and 49.5 ±11.9 years in group U. The mean stone size was 10mm (6-54mm) in group S and 19mm (8-45mm) in group U (P < .001) Mean IPA was 85.8 ±16.9 degree in group S versus 54.7 ± 11.5 degree in group U. The mean PCH was 1.9cm (0.5-4cm) in group S versus 2.3cm (0.7-3.9cm) in group U. The mean IL were 2.7 ± 0.8 cm and 3.2±0.7cm in group S and group U, respectively. The mean IWs were 0.7 cm (0.2-2.3cm) and 0.7cm (0.3-2) in group S and group U, respectively. The differences were statistically significant for IPA, PCH, IL (P < .05) while was not statistically significant for IW (P > .05). After multivariate analyses, PCH, IPA and stone size were statistically significant factors. CONCLUSION: In our study we found that IPA, PCH and stone size were significant anatomical factors affecting RIRS success in the treatment of renal lower calyx stones. The patients whose IPA, PCH and stone size valuables are unsuitable, may need multiple RIRS sessions or additionaltreatment modalities.

MRI-based reference range for the renal pelvis anterior-posterior diameter in children ages 0-19 years.

OBJECTIVE: To determine the mean and normal range of anteroposterior diameter (APD) of the renal pelves in children. METHODS: Patients aged 0-19 years with normal spinal MRIs were identified after institutional review board approval. Those with dilating uropathy or abdominal surgery/radiation were excluded. The maximum APD was measured. A mixed linear model was fit to determine the relationship between APD and age, adjusted for bladder distention. The left and right kidneys were treated independently. RESULTS: 283 left and 285 right renal units were included. For the left, a 3.5% increase in APD per year was predicted (p < 0.0001), with the average APD for infants and 18-year olds with non-distended bladders being 2.5 mm (95th percentile: 7.2 mm) and 4.6 mm (13.4 mm), respectively. For the right, a 3.9% increase in APD per year was predicted (p < 0.0001), with the average APD for infants and 18-year olds with non-distended bladders being 2.8 mm (8.4 mm) and 5.5 mm (16.6 mm), respectively. Compared with a non-distended bladder, a distended bladder increased the predicted APD between 23% (right) and 38% (left) (p = 0.01 and p < 0.0001, respectively). CONCLUSION: The mean and normal ranges of APD measured by MRI in children are provided. APD increases with age and bladder distension and is greater on the left. Advances in knowledge: This article establishes normative ranges for APD, a critical component of genitourinary tract evaluation, and does so using the most precise imaging modality for this condition.

Percent improvement in renal pelvis antero-posterior diameter (PI-APD): Prospective validation and further exploration of cut-off values that predict success after pediatric pyeloplasty supporting safe monitoring with ultrasound alone.

INTRODUCTION: Renograms are frequently obtained post-pyeloplasty in patients with residual hydronephrosis to confirm adequate drainage. Recent evidence suggests that percent improvement in antero-posterior diameter (PI-APD) ≥38 is predictive of success. We sought to further explore PI-APD ranges that would allow identification of patients who would benefit from ultrasound (US) monitoring alone vs. post-operative renal scan, and those more likely to develop recurrent ureteropelvic junction obstruction (rUPJO). METHODS: A single-center prospectively-collected pyeloplasty database (2008-2015) was queried (n = 151). Only patients with both pre- and post-operative APD measurements were included (n = 138). PI-APD was divided into 3 categories: <20%; 20-39%; ≥40%. The following variables were collected post-operatively: patients monitored with US alone, renogram and US, rUPJO and minimal or resolved hydronephrosis (SFU ≤2; UTD ≤1; APD ≤15 mm). RESULTS: Mean age at first and last follow-up were 4.8 (median 4.0; range 0-60) months and 26.6 (median 20.5; range 1-77) months, respectively. Of 138 patients, 84 (61%) had US alone, 54 (39%) had a renogram and US post-operatively, and 6 (4%) developed rUPJO. Of 84 patients who had US alone, 71 (84%; p < 0.01) demonstrated ≥40% PI-APD. Of 54 patients with renogram and US 46 (85%; p < 0.01) had ≥40 PI-APD. Of the 6 patients who developed rUPJO, all were in the <20 PI-APD group (100%; p < 0.01). Resolution of hydronephrosis according to SFU, UTD and APD occurred in 96/138 (70%), 89/138 (64%) and 113/138 (82%) patients respectively. Of these, 87 (91%), 81 (91%), and 108 (95%) occurred in >40% PI-APD group. CONCLUSION: ≥40% PI-APD at the first post-operative visit strongly predicts pyeloplasty success, as up to 82% of these patients showed resolved hydronephrosis and 61% underwent non-invasive monitoring by US alone. Our data suggests that up to 85% of renograms may have been unnecessary. Finally, <20% PI-APD permitted identification of all rUPJO cases. Stratification of patients based in PI-APD is a promising strategy for further minimizing radiation exposure while safely detecting children at risk for rUPJO.

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

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.

Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones.

PURPOSE: This study was performed to evaluate the impact of pelvicaliceal anatomy on stone clearance in patients with remnant fragments in the lower pole after flexible ureteroscopy and holmium laser lithotripsy (fURSL) for renal stones >15 mm. PATIENTS AND METHODS: This retrospective study included 67 patients with radiopaque residual fragments (>2 mm) in the lower pole after fURSL for large renal stones (>15 mm). The preoperative infundibular length (IL), infundibular width (IW), infundibulopelvic angle (IPA), and caliceal pelvic height (CPH) were measured using intravenous urography. Multivariate analysis was performed to determine whether any of these measurements affected stone clearance. RESULTS: Of the 67 patients, 55 (82.1%) were stone free (SF) 3 months after fURSL. The anatomic factors significantly favorable for an SF status were a short IL, broad IW, wide IPA, and low CPH. On multivariate analysis, the IPA had a significant influence on an SF status after fURSL (p=0.010). An IPA <30° was a negative risk factor (p=0.019). Postoperative complications occurred in nine patients (13.4%), including Clavien grade I complications in two patients (2.9%), grade II in six patients (8.9%), and grade IIIa in one patient (1.8%). Almost all complications were minor. CONCLUSIONS: An IPA <30° is the only negative risk factor for stone clearance after fURSL for large renal stones according to our multivariate analysis. Additional studies are required to further evaluate the characteristics of the pelvicaliceal anatomy influencing stone clearance.

Uropatía incrustante por Corynebacterium urealiticum: comentarios a partir de tres casos clínicos / Fouling uropathy by Corynebacterium urealyticum: Comments from three clinical cases

La uropatía incrustante es una enfermedad infecciosa del tracto urinario causada por la bacteria urealítica Corynebacterium urealyticum (CU). En nuestra serie (datos no publicados) sólo el 15% de las infecciones por CU produce uropatía incrustante. La formación de incrustaciones de estruvita y apatita en la pared del urotelio puede afectar a pelvis renal (pielitis), uréter, vejiga (cistopatía) y próstata, incluyendo la celda prostática después de resección ("celdopatía"). La pielitis es la más frecuente. La clínica corresponde a la triada orina alcalina, piuria y cristaluria de estruvita. Los pacientes suelen ser inmunodeprimidos o multioperados. El cultivo de orina debe estar dirigido al diagnóstico de CU. La TC es la prueba de imagen de elección. Muestra típicas imágenes de calcificación laminar. El tratamiento de la uropatía incrustante es multimodal. Incluye antibioterapia, acidificación de la orina y cirugía (algunos casos) (AU)

The encrustant uropathy is an infectious disease of the urinary tract caused by urealithic bacteria Corynebacterium urealyticum (CU). In our series (unpublished data) only 15% of CU infections caused encrustant uropathy. Formation of apatite and struvite on the wall of the urothelium can affect renal pelvis (pyelitis), urether, bladder (cystophatie) and prostate, including prostate cell after resection ("cellpathy"). Pyelitis is the most common. Clinical triad corresponds to alkaline urine, pyuria and struvite crystalluria. Patients are usually immunocompromised or or multiple previous surgeries. Urine culture should be directed to the diagnosis of UC. CT is the imaging test of choice. Shows typical images of laminar calcification. Treatment of encrusted uro pathy is multimodal. Includes antibiotics, acidification of urine and surgery (sometimes) (AU)

Sculpturing in urology, or how to make percutaneous nephrolithotomy easier.

PURPOSE: To investigate the usefulness of Plasticine biomodeling in surgical percutaneous management of complex renal stone. PATIENTS AND METHODS: A total of 32 patients with complex renal stones (complete staghorn stones or partial staghorn stone with multiple caliceal stones) were included in this study from 2012 to 2013. Computed tomography (CT) urography with three-dimensional (3D) reconstructions was used as standard preoperative imaging in all patients. Preoperatively, Plasticine replication of the pelvicaliceal system was performed by the operating surgeon, based on the gathered 3D reconstructions. Then the model was taken to the operating room and used as a reference model in a sterile polyethylene bag during the operation. RESULTS: Percutaneous renal access was achieved successfully in all cases. Twenty-nine (91%) patients were treated in the prone position and only 3 (9%) in supine position. There were 18 (56%) patients who had a single tract, 9 (28%) patients had two tracts, 3 (9%) patients had three tracts, and one (3%) patient needed four tracts. The mean operative time was 92 (±26) minutes. Second-look percutaneous nephrolithotomy (PCNL) was needed in 9 of 32 (28%) patients. All second-look sessions were performed in 2 to 3 days and/or on a normalized temperature. Six of 11 (54.5%) patients with complete staghorn stones needed a second-look PCNL session. Complete stone clearance was confirmed by low-dose CT, performed at 24 hours after surgery, in 89.4% of the patients treated by a single PCNL session and 82% in those who needed second-look sessions. The overall stone-free rate (SFR) in the study after second looks was 87.3%. CONCLUSIONS: The proposed Plasticine 3D model seems to provide better preoperative renal collecting system appreciation and to serve as a reference tool during the operation, which in turn might increase SFRs and lower the complications rate after PCNL.

Internal validation of the renal pelvic score: a novel marker of renal pelvic anatomy that predicts urine leak after partial nephrectomy.

OBJECTIVE: To internally validate the renal pelvic score (RPS) in an expanded cohort of patients undergoing partial nephrectomy (PN). MATERIALS AND METHODS: Our prospective institutional renal cell carcinoma database was used to identify all patients undergoing PN for localized renal cell carcinoma from 2007 to 2013. Patients were classified by RPS as having an intraparenchymal or extraparenchymal renal pelvis. Multivariate logistic regression models were used to examine the relationship between RPS and urine leak. RESULTS: Eight hundred thirty-one patients (median age, 60 ± 11.6 years; 65.1% male) undergoing PN (57.3% robotic) for low (28.9%), intermediate (56.5%), and high complexity (14.5%) localized renal tumors (median size, 3.0 ± 2.3 cm; median nephrometry score, 7.0 ± 2.6) were included. Fifty-four patients (6.5%) developed a clinically significant or radiographically identified urine leak. Seventy-two of 831 renal pelvises (8.7%) were classified as intraparenchymal. Intrarenal pelvic anatomy was associated with a markedly increased risk of urine leak (43.1% vs 3.0%; P <.001), major urine leak requiring intervention (23.6% vs 1.7%; P <.001), and minor urine leak (19.4% vs 1.2%; P <.001) compared with that in patients with an extrarenal pelvis. After multivariate adjustment, RPS (intraparenchymal renal pelvis; odds ratio [OR], 24.8; confidence interval [CI], 11.5-53.4; P <.001) was the most predictive of urine leak as was tumor endophyticity ("E" score of 3 [OR, 4.5; CI, 1.3-15.5; P = .018]), and intraoperative collecting system entry (OR, 6.1; CI, 2.5-14.9; P <.001). CONCLUSION: Renal pelvic anatomy as measured by the RPS best predicts urine leak after open and robotic partial nephrectomy. Although external validation of the RPS is required, preoperative identification of patients at increased risk for urine leak should be considered in perioperative management and counseling algorithms.

La vía supramesocólica de acceso al pedículo renal izquierdo: descripción de anatomía quirúrgica / Supramesocolic approach to the left renal pedicle: Description of the surgical anatomy

OBJETIVO: Exponer y recordar la vía de acceso supramesocólica al pedículo renal izquierdo, además de recordar las principales indicaciones de la misma. MÉTODO/RESULTADOS: Realizamos una descripción detallada de la técnica quirúrgica exponiendo sus indicaciones, la posición, incisión y sistemas de retracción utilizados y detallando los pasos llevados a cabo durante la disección. CONCLUSIÓN: El adecuado control vascular y la resección completa de grandes masas renales y suprarrenales precisan de una adecuada exposición; por lo que el conocimiento de técnicas quirúrgicas como el acceso supramesocólico al pedículo renal izquierdo es de gran utilidad y que puede facilitar el curso de cirugías retroperitoneales evitando complicaciones y aportando comodidad a actuaciones con frecuencia comprometidas

OBJECTIVE: To expose and remind the supamesocolic approach to the left renal pedicle, in addition to review its main indications. METHODS/RESULTS: We perform a detailed description of the surgical technique showing its indications, the position, the incision and retraction systems employed, detailing the steps followed during dissection. CONCLUSIONS: Adequate vascular control and complete resection of large renal and adrenal masses require an adequate exposition; the knowledge of surgical techniques such as supramesocolic approach to the left renal pedicle is very useful and may ease the course of retroperitoneal operations avoiding complications and giving comfort in a frequently difficult operation

Anderson-hynes pyeloplasty in patients less than 12 months old. Is the laparoscopic approach safe and feasible?

PURPOSE: The aim of our study is to compare the outcomes of open and laparoscopic pyeloplasty in children less than 12 months of age. PATIENTS AND METHODS: We reviewed all medical charts of patients less than 12 months old who underwent pyeloplasty from January 2007 to February 2013. We divided them in two groups: Open pyeloplasty (OP) and laparoscopic pyeloplasty (LP). The following data were analyzed: age, sex, weight, US measurements, operative time, hospital stay, complications, and success rate. Quantitative data were analyzed with the Student t test or Mann-Whitney U test, and chi-square test or Fisher test for qualitative data. RESULTS: Fifty-eight patients (46 boys and 12 girls) with a mean age of 4.66 months (±3.05) were included. Mean age was 4.25 months and 5.15 months in OP and LP group respectively. Mean weight was 6.78 kg and 7.02 kg in OP and LP groups. There were no statistical differences in age, weight, and sex between OP and LP groups. There were no statistical differences in preoperative ultrasonography measurements. Mean posterior-anterior (PA) pelvis diameter was 28.57 mm and 23.94 mm in OP and LP groups, respectively. Mean calices diameter were 10.86 mm and 10.96 mm in OP and LP groups, respectively. Mean operative time was 129.53 minutes in the OP group and 151.92 minutes in the LP group with statistical differences (P=0.018). Mean hospital stay was 6.34 days in the OP group and 3.46 in the LP group with statistical differences (P<0.05). No intraoperative and postoperative complications were found in either group. Hydronephrosis improved in all patients, and no patient needed a repeated pyeloplasty. CONCLUSION: The laparoscopic approach of Anderson-Hynes pyeloplasty in patients less than 12 months old is a safe procedure with the same outcomes as the open approach.

High-resolution mechanical imaging of the kidney.

The objective of this study was to test the feasibility and reproducibility of in vivo high-resolution mechanical imaging of the asymptomatic human kidney. Hereby nine volunteers were examined at three different physiological states of urinary bladder filling (a normal state, urinary urgency, and immediately after urinary relief). Mechanical imaging was performed of the in vivo kidney using three-dimensional multifrequency magnetic resonance elastography combined with multifrequency dual elastovisco inversion. Other than in classical elastography, where the storage and loss shear moduli are evaluated, we analyzed the magnitude |G(⁎)| and the phase angle φ of the complex shear modulus reconstructed by simultaneous inversion of full wave field data corresponding to 7 harmonic drive frequencies from 30 to 60Hz and a resolution of 2.5mm cubic voxel size. Mechanical parameter maps were derived with a spatial resolution superior to that in previous work. The group-averaged values of |G(⁎)| were 2.67±0.52kPa in the renal medulla, 1.64±0.17kPa in the cortex, and 1.17±0.21kPa in the hilus. The phase angle φ (in radians) was 0.89±0.12 in the medulla, 0.83±0.09 in the cortex, and 0.72±0.06 in the hilus. All regional differences were significant (P<0.001), while no significant variation was found in relation to different stages of bladder filling. In summary our study provides first high-resolution maps of viscoelastic parameters of the three anatomical regions of the kidney. |G(⁎)| and φ provide novel information on the viscoelastic properties of the kidney, which is potentially useful for the detection of renal lesions or fibrosis.

Microscopic anatomy and ultrastructure of the ureter of the Camelus Dromedarius ureter

The histology and ultrastructure of the ureter of Camelus dromedarius were investigated. The ureteric wall included a tunica mucosa of transitional epithelium (urothelium); an underlying loose connective tissue layer (propriasubmucosa); a tunica muscularis of smooth muscle forming inner longitudinal, middle circular, and outer longitudinal layers; and a tunica adventitia or a tunica serosa. The smooth muscle layer of the renal pelvis was scarce or lacking. The urothelium consisted of basal cuboidal to columnar cells, intermediate cells, and larger, pale superficial cells with small nuclei. The epithelium of the renal pelvis was only a few cells deep. The transitional epithelium appeared to be adapted for extensibility and water impermeability. The cytoplasm of the superficial and intermediate cells contained many membrane-bound vesicles. Junctional complexes were seen between the lateral membranes of the superficial cells providing a barrier to the passage of substances and urine into the ureteric wall. The junctional complexes and the membrane-bound vesicles may play an important role in membrane turnover and in regulating the expansion and contraction of the urothelium. In this study, we report the presence of submucosal glands in the renal pelvis of Camelus dromedarius. The serous nature of the submucosal glands, seen under the light microscope, was confirmed with the electron microscope. These glands had nearly pyramidalshaped cells lying on a basement membrane and a lumen. The cells of the epithelial lining were mainly dark with a central spherical nucleus. A connective tissue capsule could be seen around the gland (AU)

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The presence and distribution of alpha adrenergic receptors in human renal pelvis and calyces.

In this study, we aimed to demonstrate the presence of Alpha (α) 1 receptors and subtypes in human pelvis and calyces, because an agent to facilitate kidney stone movement and help decrease pain may be an α 1 adrenergic blocker, as used in ureteral stones. Twenty patients who applied to our clinic for renal cell carcinoma were enrolled to the study. All patients underwent radical nephrectomy. After the specimens were removed, excisional biopsies were performed on healthy pelvises and calyces. Mean α-receptor stain rates in renal pelvis were 2.65 ± 0.74, 1.35 ± 0.81 and 2.9 ± 0.30 for α 1A, 1B and 1D, respectively. For calyces, the rates are 2.40 ± 0.82, 1.50 ± 0.76 and 2.75 ± 0.44 for α 1A, 1B and 1D, respectively (Fig. 1). When the staining patterns were compared, α 1A and 1D were expressed more in both pelvis and calyces than α 1B (p < 0.05). After the demonstration of α-adrenergic receptors in pelvis and calyces of human kidney, it may be helpful in coming up with new alternative treatments for patients suffering from kidney stones.

Comparison of the morphometric features of the left and right horse kidneys: a stereological approach.

The aims of this study were to determine the total volume of the horse kidney and volume fractions of its functional subcomponents (cortex, medulla, renal pelvis) using stereological methods and investigate any possible difference in the functional subcomponents of the right and left kidneys that may arise from differences in shape. The study was carried out on the kidneys of 5 horses of different breed and sex. The weight of the kidneys was measured by a digital scale, and kidney volume was calculated by Archimedes' principle. Total kidney volume and volume fractions of subcomponents of the right and left kidneys were estimated by the Cavalieri's principle. The weights of the right and left kidneys were 550 ± 25 g and 585 ± 23 g, respectively. The volumes of the right and left kidneys estimated using the Cavalieri method were 542 ± 46 ml and 581 ± 29 ml. The relative organ weight of the kidneys was calculated as 1:330. The densities of the right and left kidneys were determined to be 1.01 and 1.00, respectively. The mean volume fractions of the cortex, medulla and renal pelvis were determined as 55.6, 42.7 and 1.7 in both kidneys. No statistically significant difference existed between morphometric data pertaining to the right and left kidneys (P > 0.05). To determine precisely whether differences in shape cause any difference in the functional subcomponents of the right and left kidneys requires further investigation of differences in the number of microscopically functional unit of the kidney such as renal glomeruli and nephrons.

Reproducibility of fetal renal pelvis volume assessed by three-dimensional ultrasonography with two different measurement techniques.

PURPOSE: To evaluate reproducibility of fetal renal pelvis volume as assessed by the Virtual Organ Computer Aided AnaLysis (VOCAL) imaging program and by Automatic Volume Calculation (SonoAVC). In addition, the intra- and interobserver reliability of fetal renal pelvis volume measurements with SonoAVC were established. METHODS: In this study, the fetal renal pelvis volume was measured using 3D ultrasonography in 76 kidneys of 66 fetuses with renal pelvis dilatation in the second or third trimester of pregnancy. After volume acquisition by one observer, the reproducibility of volume calculation was assessed using VOCAL imaging program and SonoAVC by two observers. Intra- and interobserver reproducibility was evaluated by calculating intraclass correlation coefficients (ICC), coefficient of variation (CV) and repeatability coefficient (r). Bland-Altman plots were generated to explore agreement. RESULTS: A high degree of reproducibility was observed between VOCAL and SonoAVC, ICC of 0.989; 95% CI 0.983-0.993, respectively. Intraobserver reproducibility of volume measurements performed by SonoAVC demonstrated a high degree of reliability with ICC of 0.995 (95% CI 0.993-0.997), CV 6.05% and r of 0.75. The interobserver reproducibility with ICC of 0.995 (95% CI 0.992-0.997), CV 10.14% and r 1.21 was also indicative of good reliability. CONCLUSION: Volume measurements of fetal renal pelvis performed by SonoAVC renders reproducible measurements in comparison with the VOCAL imaging program. There is no significant difference between VOCAL imaging program and SonoAVC. The intra- and interobserver reliability of the fetal renal pelvis measurements made by SonoAVC were considered to be very good. SonoAVC, however, needs post processing in the majority of cases but is less time consuming than VOCAL.