Department of Urology, Malatya Training and Research Hospital, Malatya, Turkey.
Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
Folia Morphol (Warsz). 2022;81(2):350-358. doi: 10.5603/FM.a2021.0041. Epub 2021 Apr 26.
Urinary system stones are frequently encountered in the community. Together with technological developments, introduction of new treatment procedures such as extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery has further reduced morbidity, mortality and hospitalisation time of patients. In order to maximise success and to reduce complications of these procedures, it is necessary to evaluate anatomy and morphological differences of kidney collector system before the procedure. This study was conducted for the purpose of determining the morphology of the kidney collector system and the negative anatomic factors of the lower pole in autopsy cases performed in our institution.
Eighty two kidney units obtained from 41 autopsy cases conducted in Faculty of Medicine Department of Forensic Medicine, Sivas Cumhuriyet University between September 2017 and September 2018 were included in the study. Percentages were found as 78% for intrarenal pelvis, 13.4% for borderline pelvis, 6.1% for extrarenal pelvis and 2.4% for pelvic nonexistence. When pelvicalyceal anatomy was evaluated, percentages were found as 32.9% for bicalyceal, 26.8% for tricalyceal, 20.7% for multicalyceal, and 19.5% for unclassified calyceality. When it was evaluated according to opening of calyces into the renal pelvis based on Sampaio classification, percentages were found as 30.5% for AI, 17.1% for type II, 28% for BI, 18.3% for BII, and 6.1% for unevaluated part. Infundibular lengths of kidney's lower pole were detected as under 3 cm in 39% and over 3 cm in 61% of all cases. Infundibulopelvic angles of kidney's lower pole were measured as under 70o in 42.7% and over 70o in 57.3% of all cases.
In our study, there was no statistically significant difference between the right and left kidneys in terms of collecting system morphology and lower pole's negative anatomical factors. Only infundibular length which is one of the collecting system morphology and lower pole's negative anatomical factors were statistically shorter in females than males. There was no difference in terms of other parameters.
In conclusion, the findings of this study are largely consistent with the results of similar studies. This reveals that renal collecting system morphology and negative anatomic factors in the lower pole collecting system in human are roughly similar. In clinical practice, pre-treatment computed tomography and, if necessary, magnetic resonance urography evaluation of the lower pole negative anatomic factors may contribute to gain preliminary information about both the clearance of stone fragments especially after shock wave lithotripsy and retrograde intrarenal surgery procedures and perioperative complications proactively.
泌尿系统结石在社区中经常遇到。随着技术的发展，体外冲击波碎石术、经皮肾镜取石术和逆行肾内手术等新的治疗方法的引入，进一步降低了患者的发病率、死亡率和住院时间。为了最大限度地提高成功率并减少这些程序的并发症，在手术前有必要评估肾脏收集系统的解剖结构和形态差异。本研究旨在确定我院尸检中肾脏收集系统的形态和下极的阴性解剖因素。
本研究纳入了 2017 年 9 月至 2018 年 9 月在锡瓦斯共和国大学医学院法医系进行的 41 例尸检中获得的 82 个肾脏单位。结果显示，肾盂内肾内肾盂占 78%，肾盂边界占 13.4%，肾盂外肾外肾盂占 6.1%，肾盂不存在占 2.4%。当评估肾盂肾盂解剖结构时，发现双肾盂占 32.9%，三肾盂占 26.8%，多肾盂占 20.7%，未分类肾盂占 19.5%。根据 Sampaio 分类，当根据肾盂进入肾盂的开口评估肾盂时，发现 AI 占 30.5%，II 型占 17.1%，BI 占 28%，BII 占 18.3%，未评估部分占 6.1%。所有病例中，肾下极漏斗长度小于 3cm 的占 39%，大于 3cm 的占 61%。所有病例中，肾下极漏斗肾盂角小于 70°的占 42.7%，大于 70°的占 57.3%。
在本研究中，右侧和左侧肾脏的收集系统形态和下极的阴性解剖因素之间没有统计学差异。只有收集系统形态和下极阴性解剖因素之一的漏斗长度在女性中比男性短。其他参数无差异。
总之，本研究的结果与类似研究的结果基本一致。这表明，人类肾脏收集系统的形态和下极收集系统的阴性解剖因素大致相似。在临床实践中，术前计算机断层扫描，如果必要，还可以进行磁共振尿路造影评估下极阴性解剖因素，可以提前获得有关冲击波碎石术和逆行肾内手术治疗后结石碎片清除情况以及围手术期并发症的初步信息。
