Intrarenal Access: 3-Dimensional Anatomical Study

Abstract

In an attempt to determine the best route to puncture and access the kidney collecting system we studied 62, 3-dimensional polyester resin endocasts of the pelvicaliceal system together with the intrarenal vessels. A retrograde pyelogram was obtained, and the arterial and venous trees were injected with red and blue resins, respectively. When the resin was still in the gel state, the kidneys were positioned at 30 to 45 degrees and the collecting system was punctured under radioscopy. Since the resin is not opaque to x-ray the operator was not able to visualize the vessels while puncturing. After puncture, the needle was maintained in place, the contrast medium was removed and the pelvicaliceal system was filled with yellow resin. After the resin had set, the renal organic matter was corroded in acid and the endocast was obtained (with the needle in the original position). This type of preparation allowed us to examine the needle tract and the vessels damaged during the puncture. In the same kidney we punctured the superior pole, mid kidney and inferior pole. In some cases we also punctured the renal pelvis. We performed 104 punctures through an infundibulum, 39 through a fornix of a calix and 12 through the renal pelvis. Due to a high percentage of vascular lesions, intrarenal access through an infundibulum should be avoided. Also, renal pelvis puncture should be avoided. Regardless of the kidney region, puncture through a fornix of a calix was safe.

Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones

“…Inadvertent infundibular puncture in the upper pole may have higher bleeding risk than lower pole. Sampaio et al 16 in another study reported that puncturing the upper pole infundibulum led to an interlobar vessel injury in two thirds of the cases, while only 13% of the patients had an arterial injury when lower pole infundibulum was punctured. Taking into consideration the above, it seems that a PCNL technique which combines the safety of a lower calyceal access without compromising SFRs would be an ideal scenario for the management of staghorn calculi.…”

The Factors That Effects Hemorrhage in Percutaneous Nephrolitotomy

“…tarafından yapılan kadavra çalışmaları ile böbrek toplayıcı sistem anatomisi ve damarsal yapıları çok iyi tanımlanmıştır. Böbreğin kaliksiyel kanlanması ve anatomik özellikler gözönüne alındığında alt kaliks girişlerinin komplikasyon açısından en güvenli yol olduğu belirtilmektedir [18]. Ancak, 2004 yılında Kukreja ve arkadaşları giriş yapılan kaliksin komplikasyon gelişimini etkilemediğini bildirmişlerdir [11].…”

A Retrospective Study of Supracostal Puncture in PCNL for the Management of Renal Calculus: Five Year Experience

“…Sampaio et al 4 reported injury to an interlobar vessel in two thirds of kidneys on puncturing the upperpole infundibulum, while only 13% of kidneys had an arterial injury when accessed through the lowerpole infundibulum. However, when the puncture was through the centre of the calyceal papilla they detected no arterial lesions.…”

“…4 Direct entry into an infundibulum risks injury to one of the interlobar vessels or segmental branches of the renal artery, resulting in significant haemorrhage. 4 Inadvertent puncture of an anterior calyx results in more parenchyma being traversed, increasing the risk of bleeding, and makes it more difficult to access the renal pelvis or other portions of the collecting system. The urologist's selection of the optimum tract based on the intrarenal anatomy and the ability to make secondary tracts as required, 5 permit more effective stone removal.…”