Marroig Bruno, Frota Rodrigo, Fortes Marco A, Sampaio Francisco J, Favorito Luciano Alves
Urogenital Research Unit, State University of Rio de Janeiro, 104/201 Tijuca, Rio de Janeiro, CEP:20271-320, Brazil.
Surg Radiol Anat. 2016 Apr;38(3):293-7. doi: 10.1007/s00276-015-1562-0. Epub 2015 Oct 6.
The aim of this paper is to analyze if the anatomy type of the collector system (CS) limits the accessibility of flexible ureteroscopy (FUR) in the lower pole.
We analyzed the pyelographies of 51 patients submitted to FUR and divided the CS into four groups: A1-kidney midzone (KM) drained by minor calices (Mc) that are dependent on the superior or on the inferior caliceal groups; A2-KM drained by crossed calices; B1-KM drained by a major caliceal group independent both of 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. With the use of a flexible ureteroscope, the access attempt was made to all of lower pole calices. Averages were statistically compared using the ANOVA and Unpaired T test (p < 0.05).
We found 14 kidneys of A1 (27.45 %); 4 of A2 (7.84 %); 17 of B1 (33.33 %); and 16 of B2 (31.37 %). The LIP was >90° in 31 kidneys (60.78 %) and between 61° and 90° in 20 kidneys (39.22 %). We did not find angles smaller than 60°. The group A1 presented 48 Mc and the UF was able to access 42 (87.5 %); the group A2 had 11 Mc and the UF was able to access 7 (63.64 %); the group B1 had 48 Mc and the UF was able to access 41 (85.42 %) and in group B2 we observed 41 Mc and the UF could access 35 (85.36 %). There was no statistical difference in the accessibility between the groups (p = 0.2610).
Collecting system with kidney midzone drained by crossed calices presented the lower accessibility rate during FUR.
本文旨在分析集合系统（CS）的解剖类型是否会限制软性输尿管镜检查（FUR）进入下极的可达性。
我们分析了51例行FUR患者的肾盂造影，并将CS分为四组：A1组——肾中区（KM）由依赖上组或下组肾小盏（Mc）引流；A2组——KM由交叉肾小盏引流；B1组——KM由独立于上、下组的一个主要肾大盏组引流，B2组——KM由直接进入肾盂的Mc引流。我们研究了肾小盏的数量、下漏斗部与肾盂之间的角度以及下漏斗部与下Mc之间的角度。使用软性输尿管镜，尝试进入所有下极肾小盏。使用方差分析和非配对t检验对平均值进行统计学比较（p<0.05）。
我们发现A1组有14个肾脏（27.45%）；A2组有4个（7.84%）；B1组有17个（33.33%）；B2组有16个（31.37%）。31个肾脏（60.78%）的下漏斗部与肾盂夹角>90°，20个肾脏（39.22%）的夹角在61°至90°之间。我们未发现小于60°的角度。A1组有48个Mc，输尿管镜能够进入42个（87.5%）；A2组有11个Mc，输尿管镜能够进入7个（63.64%）；B1组有48个Mc，输尿管镜能够进入41个（85.42%），在B2组我们观察到41个Mc，输尿管镜能够进入35个（85.36%）。各组之间的可达性无统计学差异（p = 0.2610）。
由交叉肾小盏引流的肾中区集合系统在FUR期间的可达率较低。
