The evaluation of morphology of renal pelvicalyceal system’s and infundibulopelvic anatomy of kidney’s lower pole in post-mortem series

Background: Urinary system stones are frequently encountered in the community. Together with technological developments, introduction of new treatment procedures such as extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery has furtherly reduced morbidity, mortality and hospitalization time of patients. In order to maximize success and to reduce complications of these procedures, it is necessary to evaluate anatomy and morphological differences of kidney collector system before the procedure. This study was conducted for the purpose of determining the morphology of the kidney collector system and the negative anatomic factors of the lower pole in autopsy cases performed in our institution. Materials and methods: 82 kidney units obtained from 41 autopsy cases conducted in Faculty of Medicine Department of Forensic Medicine, Sivas Cumhuriyet University between September 2017 and September 2018 were included in the study. Percentages were found as 78% for intrarenal pelvis, 13.4% for borderline pelvis, %6.1 for extrarenal pelvis and 2.4% for pelvic nonexistence. When pelvicalyceal anatomy was evaluated, percentages were found as 32.9% for bicalyceal, 26.8% for tricalyceal, 20.7% for multicalyceal and 19.5% for unclassified calyceality. When it is evaluated according to opening of calyces into the renal pelvis based on Sampaio classification, percentages were found as 30.5% for AI, 17.1% for Type II, 28% for BI, 18.3% for BII and 6.1% for unevaluated part. Infundibular lengths of kidney’s lower pole were detected as under 3 cm in 39% and over 3 cm in 61% of all cases. Infundibulopelvic angles of kidney’s lower pole were measured as under 70 0 in 42.7% and over 70 0 in 57.3% of all cases. Results: In our study, there was no statistically significant difference between the right and left kidneys in terms of collecting system morphology and lower pole’s negative anatomical factors. Only infindibular lengths which is one of the collecting system morphology and lower pole’s negative anatomical factors were statistically shorter in females than males. There was no difference in terms of other parameters. Conclusions: In conclusion, the findings of this study are largely consistent with the results of similar studies. This reveals that renal collecting system morphology and negative anatomic factors in the lower pole collecting system in human are roughly similar. In clinical practice, pre-treatment CT and, if necessary, MR urography evaluation of the lower pole negative anatomic factors may contribute to gain preliminary information about both the clearance of stone fragments especially after SWL and RIRS procedures and perioperative complications proactively.