Gandhi Kusum Rajendra, Chavan Sushama
Department of Anatomy, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Department of Anatomy, Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India.
Asian J Urol. 2019 Jul;6(3):249-255. doi: 10.1016/j.ajur.2018.12.006. Epub 2018 Dec 21.
Renal collecting system macroscopically consists of minor calyx, major calyx, renal pelvis and ureter. Stone in renal collecting system is a common presentation in everyday urological practice. The prevalence of renal calculi ranges from 4% to 20% in different geographical distribution. Anatomical variation in renal collecting system plays a significant role in formation of calculi in its parts. The large extra renal pelvis leads to stagnation of urine for longer durations and formation of stones. The stone free rate after percutaneous nephrolithotomy and extra corporeal shock wave lithotomy is significantly related to anatomical factors, particularly the type of renal pelvis and dimensions (length and width) of lower infundibulum. Previous authors described the morphology of pelvicalyceal system in a highly variable manner and the available anatomical description of pelvicalyceal system is contradictory and incomplete. Hence an attempt has been made to provide the precise anatomy of pelvicalyceal system in adult human kidneys.
We studied 196 formalin embalmed kidneys to note the number of infundibulum, major and minor calyces. The location and shape of pelvis were also studied.
The intra-renal pelvis was narrow and had funnel shaped appearance in 95 of total 196 (48.5%) specimens, and the extra-renal pelvis was dilated as balloon shaped in 43 of 196 (21.9%) specimens. In 41 (20.9%) specimens, the renal pelvis was having partially intra- and extra-renal in location. Bilateral symmetry was found in only 27.1% of 196 renal collecting systems. The length of lower infundibulum was more than 22 mm in 19 (9.7%) of 196 cases which directly affects the stone clearance rate during open and endoscopic surgeries on pelvicalyceal system.
This study provides the accurate morphological details of the shape and dimensions of renal pelvicalyceal system to help the urologists and nephrologists.
肾集合系统在宏观上由肾小盏、肾大盏、肾盂和输尿管组成。肾集合系统结石是日常泌尿外科实践中的常见表现。在不同地理分布区域，肾结石的患病率在4%至20%之间。肾集合系统的解剖变异在其各部位结石形成中起重要作用。巨大的肾外肾盂会导致尿液长期潴留并形成结石。经皮肾镜取石术和体外冲击波碎石术后的结石清除率与解剖因素显著相关,特别是肾盂类型和下肾盏漏斗部的尺寸（长度和宽度）。既往作者对肾盂肾盏系统形态的描述差异很大，现有的肾盂肾盏系统解剖描述相互矛盾且不完整。因此，我们试图提供成年人类肾脏肾盂肾盏系统的精确解剖结构。
我们研究了196个用福尔马林防腐固定的肾脏，以记录肾盏漏斗部、大肾盏和小肾盏的数量。同时还研究了肾盂的位置和形态。
在196个标本中的95个（48.5%）中，肾盂内型狭窄，呈漏斗状；在196个标本中的43个（21.9%）中，肾外型肾盂扩张，呈气球状。在41个（20.9%）标本中，肾盂部分位于肾内和肾外。在196个肾集合系统中,仅27.1%发现双侧对称。在196例中的19例（9.7%）中,下肾盏漏斗部长度超过22毫米，这直接影响了肾盂肾盏系统开放手术和内镜手术中的结石清除率。
本研究提供了肾盂肾盏系统形状和尺寸准确形态学细节，以帮助泌尿外科医生和肾脏科医生。
