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The anatomy of the renal pyelocaliceal system studied by CTU

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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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Author notes

  1. Saskia Weltings and Sander Hulsbos contributed equally to this article.

Authors and Affiliations

  1. Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands

    Saskia Weltings, Sander Hulsbos & Hossain Roshani

  2. Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands

    Gerard J. Kieft

  3. Department of Urology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands

    Rob C. M. Pelger

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  1. Saskia Weltings
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  2. Sander Hulsbos
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  3. Gerard J. Kieft
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  4. Rob C. M. Pelger
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  5. Hossain Roshani
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Correspondence to Saskia Weltings.

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Weltings, S., Hulsbos, S., Kieft, G.J. et al. The anatomy of the renal pyelocaliceal system studied by CTU. Abdom Radiol 44, 612–618 (2019). https://doi.org/10.1007/s00261-018-1767-x

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