Muhammad Shahbaz Hanif, Mubashar Husain Toori, Masood Ahmed Sheikh.
Detailed calyceal anatomy for endourology.
Pak J Med Res Jan ;43(4):184-7.

Objectives: To understand the detailed calyceal anatomy in our population for endourological procedures. Material and methods: Fifty patients were selected randomly in the Jinnah Postgraduate Medical Centre Karachi, from January to December 2003 who have been investigated with CT Scan abdomen with contrast. All those patients found to have ectopic or malrotaded kidneys were excluded from the study. Similarly patients of renal tumor causing distortion of renal anatomy were also excluded from the study. Anatomy of the kidneys was studied with the help of delayed images of CT scan of abdomen with intravenous contrast delineating the pelvicalyceal system. Degree of rotation of the kidney in longitudinal axis with respect to coronal plane of the body was noted. Angulation of both anterior and posterior calyx with respect to frontal plane of kidney was measured. Results: Total 80 kidneys were studied including 42 right and 38 left. On average right sided kidneys were rotated posteriorly 35 degree and left sided 22 degree with respect to the coronal plane of the body. Average rotation of the posterior calyces was found 26 degree on the right and 48 degree on the left. Conclusion: Elevating the operating side 30 degree upward on the right and 20 degree on the left side of a prone patient makes the posterior calyces almost end on which helps in gaining the initial access to collecting system during percutaneous nephrolithotomy and thus decreases the intraoperative complications. Understanding of detailed calyceal system also helps to make 3 dimensional image of the renal collecting system from a standard IVU (Intravenous urography),to exactly localize the stone bearing calyx and for later on flexible nephroscopy.

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