The impact of pelvicaliceal anatomical variation between the stone-bearing and normal contralateral kidney on stone formation in adult patients with lower caliceal stones

Abstract

Objective: We aimed to investigate the effect of pelvicaliceal anatomical differences on the etiology of lower caliceal stones. Materials and Methods: Records of adult patients between January 1996 and December 2005 with solitary lower caliceal stone were reviewed. After exclusion of patients with hydronephrosis, major renal anatomic anomalies, non-calcium stones, history of recurrent stone disease and previous renal surgery, 78 patients were enrolled into the study. Lower pole infundibulopelvic angle (IPA), infundibulovertebral angle (IVA), infundibular length (IL), width (IW), number of minor calices and cortical thickness of the lower pole together with other caliceal variables obtained from the whole pelvicaliceal anatomy of both stone-bearing and contralateral normal kidneys were measured from intravenous pyelogram of the patients. Total pelvicaliceal volume was also calculated by a previously described formula for both kidneys. Results: There were statistically significant difference between two kidneys in terms of IW (p < 0.001) and IL (p = 0.002) of the upper calyx, IW (p = 0.001) and IVA (p < 0.001) of the lower calyx), pelvicaliceal volume (p < 0.001), IPA of middle calyx (p = 0.006) and cortical thickness over the lower pole (p < 0.001). However there was no difference between stonebearing and contralateral normal kidneys in terms of lower pole IPA (p = 0.864) and IL (p = 0.568). Conclusion: Pelvicaliceal volume but not lower caliceal properties seem to be a risk factor for stone formation in lower calyx.

Anatomical study of the renal excretory system in pigs. A review of its characteristics as compared to its human counterpart

“…Since early hydronephrosis expresses itself morphologically with the presence of an ampullar pelvis in humans, it has been postulated that before labelling this feature as an anatomical variant in the clinical scenario, one must rule out an urinary tract obstruction generated by lithiasis, stenosis of the pyeloureteral junction, vesicoureteral reflux, or extrinsic compression caused by light adhesions of the lower polar renal arteries or the gonadal vessels [6,35]. Similarly, it has been postulated that since bifurcated renal pelvises handle smaller urinary volumes, they could become an anatomical substrate for the formation of stones inside these structures [1,18].…”

The impact of pelvicalyceal anatomy on the stone formation in patients with lower pole renal stones

“…In that study IPA constituted a statistically significant risk factor for lower incidence of calyceal stones [12]. Kupeli et al [10] in their analysis of the effect of morphological structure of the inferior calyx on development of nephrolithiasis demonstrated absence of any significant correlations between the IPA of the lower pole and formation of stones. Besides morphology of the inferior calyx, structure of the whole renal collective system was analysed in that study.…”

“…In our study none of the infundibular factors were significantly different between the affected and unaffected kidney. Kupeli et al [10] reported statistically significant differences in lower calyceal IW (p = 0.001) between the stone-bearing kidney and the contralateral kidney, although there were no differences in lower calyceal IL (p = 0.568). Similarly to IPA, IW is a significant factor affecting the post-ESWL stone-free.…”

“…Besides morphology of the inferior calyx, structure of the whole renal collective system was analysed in that study. Statistically significant differences were demonstrated only for the middle calyceal IPA [10]. Similarly, Gurocak et al [8] compared 119 lower calyceal stone-forming kidneys and concluded that lower pole IPA was not an important factor for stone formation in the lower calyx.…”

Study of variations in the pelvicalyceal system of kidney and its clinical importance

“…In study conducted by Kupeli Bora et al 3 pelvicalyceal anatomy will be of immense value to the clinicians of related specialties.…”