Role of kidney stones in renal pelvis flow

Abstract

We examine the time-dependent flow dynamics inside an idealised renal pelvis in the context of a surgical procedure for kidney stone removal, extending previous work by Williams et al. (2020aWilliams et al. ( , 2021, who showed how vortical flow structures can hinder mass transport in a canonical two-dimensional domain. Here, we examine the time-dependent evolution of these vortical flow structures in three-dimensions, and incorporate the presence of rigid kidney stones. We perform direct numerical simulations, solving the transient Navier-Stokes equations in a spherical domain. Our numerical predictions for the flow dynamics in the absence of stones are validated with experimental and 2D numerical data from Williams et al. (2020a), and the governing parameters and flow regimes are chosen carefully in order to satisfy several clinical constraints. The results shed light on the crucial role of flow circulation in the renal cavity and its effect on the trajectories of rigid stones. We demonstrate that stones can either be washed out of the cavity along with the fluid, or be trapped in the cavity via their interaction with vortical flow structures. Additionally, we study the effect of multiple stones in the flow field within the cavity in terms of the kinetic energy, entrapped fluid volume, and the clearance rate of a passive tracer modelled via an advection-diffusion equation. We demonstrate that the flow in the presence of stones features a higher vorticity production within the cavity compared with the stone-free cases. Impact StatementInnovative numerical algorithms for complex fluid flows together with high-performance computing architectures can deliver an in-depth understanding of the flow physics of previously inaccessible problems. In this research we have performed numerical solutions of ureteroscopy flows to provide a better understanding of the dynamics of kidney stones during ureteroscopy, a surgical procedure designed to remove kidney stones. For the first time (to the best of our knowledge), we have illustrated the role of rigid stones inside an idealised renal pelvis. This research has the potential to provide a better understanding of the flow dynamics within the cavity during ureteroscopy and subsequently could lead to better surgical practices.