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Zhu W, Zheng M, Xiong S, Han G, Meng C, Li Z, Zhang L, Xiong G, Guan H, Huang Y, Zhu H, Li X, Wang G, Zhou L. Modified Takazawa anatomical classification of renal pelvicalyceal system based on three-dimensional virtual reconstruction models. Transl Androl Urol 2021; 10:2944-2952. [PMID: 34430397 PMCID: PMC8350222 DOI: 10.21037/tau-21-309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/02/2021] [Indexed: 01/18/2023] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Mengmeng Zheng
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Yanbo Huang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Gang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
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Karim SS, Hanna L, Geraghty R, Somani BK. Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones: outcomes with a systematic review of literature. Urolithiasis 2019; 48:263-270. [PMID: 31372691 PMCID: PMC7220875 DOI: 10.1007/s00240-019-01150-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Sulaiman Sadaf Karim
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Luke Hanna
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Robert Geraghty
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
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Weltings S, Hulsbos S, Kieft GJ, Pelger RCM, Roshani H. The anatomy of the renal pyelocaliceal system studied by CTU. Abdom Radiol (NY) 2019; 44:612-618. [PMID: 30196360 DOI: 10.1007/s00261-018-1767-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Knowledge of the pyelocaliceal system anatomy is essential for the safe and successful performance of endourologic procedures. The purpose of this study was to provide a better understanding of the full three-dimensional pyelocaliceal system anatomy. METHODS Morphometric parameters of the three-dimensional reconstructions of computed tomography intravenous urography scans (n = 25 scans) were analyzed. Both kidneys were divided into three equal-sized segments (US: upper segment, MS: mid segment, LS: lower segment). Infundibular length (IL), infundibular width (IW), the number of calyces, and the transverse orientation in hours of a clock of each calyx as well as the dimension of the pyelum were determined. RESULTS The mean upper IL (n = 92) was longer than the middle (n = 154) and lower IL (n = 112) (30.6 ± 7.9 mm vs. 16.4 ± 7.7 mm vs. 16.0 ± 6.0 mm, respectively; P = < 0.0001). IW was significantly smaller in the MS [3.7 ± 1.9 mm], followed by the US [4.6 ± 1.9 mm], and the LS [4.9 ± 2.2] in the increasing order. No correlation was found between IL and IW (Pearson correlation coefficient = 0.1). The US calyces were predominantly orientated lateral (8-10 o'clock: 44.5%) and medial (2-4 o'clock: 30.5%), in the MS lateral (8-10 o'clock: 87.6%) and anterolateral in the LS (9-12 o'clock: 67.9%). 74% of the kidneys consisted of 6-8 calyces (mean 7.2 ± 1.4, range 4-10), with the majority of the calyces in the MS (3.1 ± 0.8) followed by the LS (2.24 ± 0.8), and US (1.8 ± 0.7). There were no statistical differences between the right and left kidneys in terms of IL (P = 0.112) and number of calyces (P = 0.685). CONCLUSION Anatomic differences between the three segments of the pyelocaliceal system in terms of IL, IW, calyces number, and orientation are seen and should be considered when performing an endourologic procedure.
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Affiliation(s)
- Saskia Weltings
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands.
| | - Sander Hulsbos
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Gerard J Kieft
- Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Hossain Roshani
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands
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Marroig B, Frota R, Fortes MA, Sampaio FJ, Favorito LA. Influence of the renal lower pole anatomy and mid-renal-zone classification in successful approach to the calices during flexible ureteroscopy. Surg Radiol Anat 2015; 38:293-7. [PMID: 26438274 DOI: 10.1007/s00276-015-1562-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE 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. METHODS 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). RESULTS 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). CONCLUSIONS Collecting system with kidney midzone drained by crossed calices presented the lower accessibility rate during FUR.
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Affiliation(s)
- Bruno Marroig
- Urogenital Research Unit, State University of Rio de Janeiro, 104/201 Tijuca, Rio de Janeiro, CEP:20271-320, Brazil
| | - Rodrigo Frota
- Urogenital Research Unit, State University of Rio de Janeiro, 104/201 Tijuca, Rio de Janeiro, CEP:20271-320, Brazil
| | - Marco A Fortes
- Urogenital Research Unit, State University of Rio de Janeiro, 104/201 Tijuca, Rio de Janeiro, CEP:20271-320, Brazil
| | - Francisco J Sampaio
- Urogenital Research Unit, State University of Rio de Janeiro, 104/201 Tijuca, Rio de Janeiro, CEP:20271-320, Brazil
| | - Luciano Alves Favorito
- Urogenital Research Unit, State University of Rio de Janeiro, 104/201 Tijuca, Rio de Janeiro, CEP:20271-320, Brazil.
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Marroig B, Favorito LA, Fortes MA, Sampaio FJB. Lower pole anatomy and mid-renal-zone classification applied to flexible ureteroscopy: experimental study using human three-dimensional endocasts. Surg Radiol Anat 2015; 37:1243-9. [PMID: 26044783 DOI: 10.1007/s00276-015-1503-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/29/2015] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Bruno Marroig
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciano Alves Favorito
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
- , Rua Professor Gabizo, 104/201, Tijuca, Rio de Janeiro, RJ, 20271-320, Brazil.
| | - Marco A Fortes
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco J B Sampaio
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Inoue T, Murota T, Okada S, Hamamoto S, Muguruma K, Kinoshita H, Matsuda T. Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones. J Endourol 2015; 29:998-1005. [PMID: 25879676 DOI: 10.1089/end.2015.0071] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Takaaki Inoue
- 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan
| | - Takashi Murota
- 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan
| | - Shinsuke Okada
- 2 Department of Urology, Gyotoku General Hospital , Ichikawa City, Japan
| | - Shuzo Hamamoto
- 3 Department of Urology, Toyota Kousei Hospital , Toyota City, Japan
| | - Kouei Muguruma
- 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan
| | - Hidefumi Kinoshita
- 4 Department of Urology, Hirakata Hospital, Kansai Medical University , Hirakata City, Japan
| | - Tadashi Matsuda
- 4 Department of Urology, Hirakata Hospital, Kansai Medical University , Hirakata City, Japan
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Kim TB, Lee SC, Kim KH, Jung H, Yoon SJ, Oh JK. The feasibility of shockwave lithotripsy for treating solitary, lower calyceal stones over 1 cm in size. Can Urol Assoc J 2013; 7:E156-60. [PMID: 23589749 DOI: 10.5489/cuaj.473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Recently, few studies were reported about the treatment of large, solitary, renal calculi between shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PNL). We assess the feasibility of SWL for managing solitary, lower calyceal stones over 1 cm by comparing the results of lower pole calculi treatment between patients that underwent SWL or PNL. METHODS We retrospectively reviewed clinical data for patients who had undergone PNL or SWL due to lower calyceal stones over 1 cm. Group 1 consisted of patients who underwent SWL to treat lower pole renal calculi from 2010 to 2011. Group 2 included patients who underwent PNL to manage lower pole renal calculi from 2008 to 2009. We compared patient age, gender, stone size, comorbidities, postoperative complications, additional interventions and anatomical parameters between the two groups. RESULTS A total of 55 patients were enrolled in this study. The mean ages (±SD) of groups 1 (n = 33) and 2 (n = 22) were 55.1 (±13.0) and 50.0 (±10.6) years (p = 0.133) and mean stone sizes were 1.6 (±0.7) and 1.9 (±0.8) cm (p = 0.135), respectively. There were no significant differences in gender distribution, comorbidities or stone laterality between the two groups. No significant differences in various parameters were observed between patients with stones 1 to 2 cm and ones with stones 2 cm or larger. CONCLUSIONS Our results demonstrated that SWL is a safe, feasible treatment for solitary, lower calyceal stones over 1 cm.
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Affiliation(s)
- Tae Beom Kim
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
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