The Peak Site of Stone Distribution in the Upper Ureter is Unlikely the Ureteropelvic Junction: Computed Tomography Analysis of Stone Lodging Site With Respect to a Newly Identified Area of Constriction

Nozaki, Taiki; Starkey, Jay; Horiuchi, Saya; Muraishi, Natsuka; Hattori, Kazunori; Akita, Keiichi

doi:10.1016/j.urology.2017.05.045

Cited by 4 publications

(2 citation statements)

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“…In another study, we investigated CT images of patients who presented to the emergency department with acute back pain and were diagnosed with acute renal colic [13]. We discovered that the peak site of urinary stone distribution in the upper ureter was corresponding approximately to the level The ureter is first located in the perirenal portion; thereafter, it is fixed firmly to the anteromedial aspect of the psoas major muscle.…”

Section: Do Urinary Tract Stones Lodge At the Crossing Point?mentioning

confidence: 99%

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There are no three physiological narrowings in the upper urinary tract: a new concept of the retroperitoneal anatomy around the ureter

et al. 2021

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The widely held dogma of three physiological narrowings in the upper urinary tract has proven incorrect by recent several studies using computed tomography images. There are only two common obstruction sites: the upper ureter and the ureterovesical junction. The second narrowing, where the ureter crosses the iliac vessels, cannot be regarded anymore as a common obstruction site. The mechanism by which stones lodge in the upper ureter is explained anatomically by the change in ureteral mobility and compliance at the level where the ureter exits the perirenal space. This level can be identified radiologically as the point where the ureter crosses under the ipsilateral gonadal veins, termed the “crossing point”. Kinking of the upper ureter is another manifestation of this anatomical phenomenon, visible in radiological images. It is caused by loosening of the ureter at or above the crossing point (within the perirenal space), corresponding with renal descent such as during the inspiratory phase. This new anatomical discovery in the retroperitoneum will not only bring about a paradigm shift in terms of the physiological narrowings in the upper urinary tract, but may also lead to the development of new surgical concepts and approaches in the area.

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Section: Do Urinary Tract Stones Lodge At the Crossing Point?mentioning

confidence: 99%

“…Fig. 4 Box plot of the distance between the crossing point and stone location (as discovered in [13]). The peak site of urinary stone distribution in the upper ureter is corresponding approximately to the level of the crossing point on both sides.…”

Section: Is the Crossing Point Different From The Ureteropelvic Junctmentioning

confidence: 99%