Complex multiple renal calculi: stone distribution, pelvicalyceal anatomy and site of puncture as predictors of PCNL outcome

Verma, Amit; Tomar, Vinay; Yadav, Sher Singh

doi:10.1186/s40064-016-3017-4

Cited by 14 publications

(11 citation statements)

References 15 publications

(16 reference statements)

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“…Clinically, the extra-renal pelvis is roomier and more convenient to explore during nephron sparing surgery and partial nephrectomy than the intra-renal pelvis because it provides larger surface area away from the renal vasculature for safe surgery but the drawback is that the larger pelvic space aggravates accumulation and stasis of urine predisposing formation of renal calculi [9] . A distended renal pelvis and collecting system facilitate the puncture, placement, and maneuvering of the endourologic instruments and by providing a larger fluid chamber around a stone, enhance the efficacy of ESWL [11] , [12] , [13] , [14] . Kupeli et al.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the morphology of pelvicalyceal system in human cadaveric kidneys with a systematic review of literature

Gandhi

Chavan

2019

Asian Journal of Urology

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Objective Renal collecting system macroscopically consists of minor calyx, major calyx, renal pelvis and ureter. Stone in renal collecting system is a common presentation in everyday urological practice. The prevalence of renal calculi ranges from 4% to 20% in different geographical distribution. Anatomical variation in renal collecting system plays a significant role in formation of calculi in its parts. The large extra renal pelvis leads to stagnation of urine for longer durations and formation of stones. The stone free rate after percutaneous nephrolithotomy and extra corporeal shock wave lithotomy is significantly related to anatomical factors, particularly the type of renal pelvis and dimensions (length and width) of lower infundibulum. Previous authors described the morphology of pelvicalyceal system in a highly variable manner and the available anatomical description of pelvicalyceal system is contradictory and incomplete. Hence an attempt has been made to provide the precise anatomy of pelvicalyceal system in adult human kidneys. Methods We studied 196 formalin embalmed kidneys to note the number of infundibulum, major and minor calyces. The location and shape of pelvis were also studied. Results The intra-renal pelvis was narrow and had funnel shaped appearance in 95 of total 196 (48.5%) specimens, and the extra-renal pelvis was dilated as balloon shaped in 43 of 196 (21.9%) specimens. In 41 (20.9%) specimens, the renal pelvis was having partially intra- and extra-renal in location. Bilateral symmetry was found in only 27.1% of 196 renal collecting systems. The length of lower infundibulum was more than 22 mm in 19 (9.7%) of 196 cases which directly affects the stone clearance rate during open and endoscopic surgeries on pelvicalyceal system. Conclusion This study provides the accurate morphological details of the shape and dimensions of renal pelvicalyceal system to help the urologists and nephrologists.

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Section: Discussionmentioning

confidence: 99%

Revisiting the morphology of pelvicalyceal system in human cadaveric kidneys with a systematic review of literature

Gandhi

Chavan

2019

Asian Journal of Urology

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“…26 The S. documented that the infundibular width, IPA, and pelvicalyceal volume significantly affected the SF status. 29 On the other hand, Binbay et al documented that only the pelvicalyceal volume significantly affected the success rate of PCNL, while PCS anatomy did not affect outcomes. 30 In this study, we divided the PCS anatomy into two groups using the Takazawa classification, 12 and some reports have proposed the classification of pelvicalyceal patterns.…”

Section: Discussionmentioning

confidence: 99%

Impact of pelvicalyceal anatomical variation on surgical outcomes of endoscopic combined intrarenal surgery

et al. 2022

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Objectives: The objective of this work is to investigate the impact of the pelvicalyceal anatomical system (PCS) on calyceal stone formation and surgical outcomes of endoscopic combined intrarenal surgery (ECIRS) for renal and/or proximal ureteral stones with a diameter >15 mm.Patients and methods: PCS was classified as Type I (single pelvis) or Type II (divided pelvis) according to the simple anatomical Takazawa classification. Using prospectively collected data from January 2016 to April 2020, 219 patients were retrospectively reviewed. After excluding patients who underwent a staged procedure, had hydronephrosis greater than grade 2, prior nephrostomy tubes, and failed to access the renal collecting system, 115 patients (Type I: 81, Type II: 34) were included, and the distribution of calyceal stones and surgical outcomes in ECIRS were compared between Types I and II PCS. Results:The median number of renal stone calyces in the Type II group was significantly more than that in the Type I group (p = 0.016). In particular, the Type II group possessed more upper stone calyces. Multivariate logistic regression analysis revealed that Type II PCS was associated with an increased odds ratio (OR) for the presence of upper stone calyces (OR: 2.93, p = 0.018). The stone-free (SF) status at 1 month after surgery, confirmed by abdominal plain radiography, was significantly higher in the Type I group compared with that in Type II (67.9% vs. 39.4%, respectively; p = 0.006). The requirement for additional surgical interventions was significantly higher in the Type II group compared with that in Type I (35.4% vs. 7.4%, respectively; p < 0.001). Multivariate analysis revealed that the number of stone calyces (OR: 4.26; p = 0.001) and Type II PCS (OR: 3.43; p = 0.009) were independent predictors of residual stones after ECIRS.

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“…The upper renal pole is anatomically more posteromedial than a lower pole, so access via the upper pole is more straight as compared to the middle and lower poles. 5 With this approach access to the lower calyx, renal pelvis, and upper ureter can be easily achieved if the initial puncture is appropriate. 6 Careful preoperative assessment of pelvicalyceal system anatomy with the help of renal ultrasound or intravenous urography or CT KUB and intraoperative retrograde pyelography(RPG) can help to select the site of percutaneous puncture for kidney stone retrieval, most stones can be approached subcostally but sometimes if the subcostal approach is not appropriate then the supracostal approach can also be utilized.…”

Section: Introductionmentioning

confidence: 99%

Safety of Supracostal Percutaneous Nephrolithotomy in Paediatric Population: A Single Centre Experience

Khan¹,

Ullah

Mohayuddin

et al. 2022

JRMC

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Objective The objective of this study is assessment of safety and efficacy of supracostal mini percutaneous nephrolithotomy in pediatric patients. Methodology This is prospective study of patients whose kidney stones were treated with mini percutaneous nephrolithotomy through supracostal approach between February 2019 and Dec 2020.These patients were selected for supracostal puncture based on preoperative ultrasound and CT KUB findings and peroperative assessment of stone burden, stone location and anatomy of pelvicalyceal system. Results Of 80 patients 72(90%) were treated with only one supracostal puncture while additional 2nd puncture was used for 8(10%) patients. Overall stone clearance is 85% only with percutaneous nephrolithotomy and the stone clearance has reached to 95% with ancillary procedures.13% of patient had hydrothorax , 3.75% had urosepsis, 2.75% had bleeding and 1.25 % had perinephric fluid collection. Conclusion This study concludes that the safety and efficacy of supracostal percutaneous nephrolithotomy is same as subcostal pcnl if surgical boundaries are not violated.

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Complex multiple renal calculi: stone distribution, pelvicalyceal anatomy and site of puncture as predictors of PCNL outcome

Cited by 14 publications

References 15 publications

Revisiting the morphology of pelvicalyceal system in human cadaveric kidneys with a systematic review of literature

Revisiting the morphology of pelvicalyceal system in human cadaveric kidneys with a systematic review of literature

Impact of pelvicalyceal anatomical variation on surgical outcomes of endoscopic combined intrarenal surgery

Safety of Supracostal Percutaneous Nephrolithotomy in Paediatric Population: A Single Centre Experience

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