Zhu Weijie, Zheng Mengmeng, Xiong Shengwei, Han Guanpeng, Meng Chang, Li Zhihua, Zhang Lei, Xiong Gengyan, Guan Hua, Huang Yanbo, Zhu Hongjian, Li Xuesong, Wang Gang, Zhou Liqun
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Transl Androl Urol. 2021 Jul;10(7):2944-2952. doi: 10.21037/tau-21-309.
Previous classification of renal pelvicalyceal anatomical structure may be difficult to intuitively understand and unpractical for endourological surgery. We aim to put forward a modified Takazawa anatomical classification of renal pelvicalyceal system based on three-dimensional (3D) virtual reconstruction models for endourological surgery.
We retrospectively collected data on 225 patients (320 kidneys) in total between Apr. 2017 and Dec. 2020, spatial anatomical structure of renal pelvis and calyces were modeled and corresponding morphological parameters were measured after 3D virtual reconstruction of computed tomography urography (CTU). The modified Takazawa renal pelvicalyceal anatomical classification was advanced based on the renal pelvicalyceal morphological parameters [bifurcated branches of renal pelvis, cross sectional area of renal pelvis and ureteropelvic junction (UPJ), infundibuloureteral angle (IUA), lower pole infundibular calyceal length (IL)] by 3D virtual reconstruction models, and comparison of renal pelvicalyceal system morphological parameters were performed to evaluate the differences in various classification types of renal pelvis and calyces.
Anatomical structure of renal pelvis and calyces were divided into two main types (Type A and Type B) according to renal pelvic branch patterns. A single pelvis without bifurcated branch was regarded as Type A (62%) and subclassified into three subtypes: Type A1 (22%), Type A2 (27%) and Type A3 (13%), the slimline pelvis was classified as Type A1, the typical pelvis as Type A2 and the broad pelvis as Type A3. A divided pelvis with bifurcated branches was seen as Type B (38%) and subclassified into two subtypes: Type B1 (15%) with the wide and flat lower calyx branch, Type B2 (23%) with the narrow and steep lower calyx branch.
Previous studies have reported that the visualization and classification of renal pelvicalyceal anatomical structure by endocast, autopsy, ultrasonography and excretory urography, the modified Takazawa classification system based on 3D virtual reconstruction models enables to standardized different anatomical morphology of renal pelvicalyceal system and provide intuitive and concise information on anatomy, thus leading to the improvement in treatment modality.
既往肾盂肾盏解剖结构分类对于腔内泌尿外科手术而言，可能难以直观理解且不实用。我们旨在基于三维（3D）虚拟重建模型提出一种改良的高泽肾盂肾盏解剖分类，用于腔内泌尿外科手术。
我们回顾性收集了2017年4月至2020年12月期间总共225例患者（320个肾脏）的数据，对计算机断层扫描尿路造影（CTU）进行3D虚拟重建后，对肾盂和肾盏的空间解剖结构进行建模，并测量相应的形态学参数。基于肾盂肾盏形态学参数[肾盂分支、肾盂和输尿管肾盂连接处（UPJ）的横截面积、漏斗输尿管角（IUA）、下极漏斗状肾盏长度（IL）]，通过3D虚拟重建模型提出改良的高泽肾盂肾盏解剖分类，并对肾盂肾盏系统形态学参数进行比较，以评估不同分类类型的肾盂和肾盏的差异。
根据肾盂分支模式，肾盂和肾盏的解剖结构分为两种主要类型（A型和B型）。无分支的单一肾盂被视为A型（62%），并进一步细分为三个亚型：A1型（22%）、A2型（27%）和A3型（13%），纤细型肾盂归类为A1型，典型型肾盂为A2型，宽阔型肾盂为A3型。有分支的分叶肾盂被视为B型（38%），并进一步细分为两个亚型：下肾盏分支宽且平的B1型（15%），下肾盏分支窄且陡的B2型（23%）。
既往研究报道了通过铸型、尸检、超声检查和排泄性尿路造影对肾盂肾盏解剖结构进行可视化和分类，基于3D虚拟重建模型的改良高泽分类系统能够使肾盂肾盏系统的不同解剖形态标准化，并提供直观且简洁的解剖学信息，从而改善治疗方式。
