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Título

ANATOMIC AND RADIOLOGIC STUDY OF THE PELVICALYCEAL SYSTEM OF HORSESHOE KIDNEY AND PYELOURETERAL DUPLICATION APPLIED TO LOWER POLE LITHIASIS TREATMENT AND ENDOUROLOGIC TRAINING

Resumo

Purpose: To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with pyeloureteral duplication (PUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan).
Material and Methods: We analyzed 20 three-dimensional (3D) polyester resin endocasts of the kidney collecting system belonging to our research unit. Among them, three were HK, seven had PUD and ten were 3D endocasts of kidneys without macroscopic anomalies (Control group - CG). We also analyzed 24 patients through 3D computerized tomography scan (CT-scan) reconstruction images of kidneys. Among them, six were from patients with HK, eight had PUD kidneys and 10 patients had no kidney anomalies (used as CG).
We studied the number of calyces, width and length of the infundibulum and the minor calyces and the angles between the lower infundibulum and renal pelvis (LIP) and between the lower infundibulum and the lower minor calyces (LIICA) in the lower pole. We also studied usable data that were obtained from CT-scan in Digital Imaging and Communications in Medicine (DICOM) format. These DICOM images were processed with the Simplify3D® software and were printed using a Flashforge Dreamer® 2018 printer. The models were made of polylactic acid (PLA) and acrylonitrile butadiene styrene (ABS) with diameter of 1.75 millimeters. The navigation was performed by the same observer with a flexible digital ureteroscope (Endomaster®). Mean values were statistically compared using ANOVA with the Kruskal-Wallis test and unpaired t-test. The data were analyzed with IBM® SPSS® Statistics software.
Results: There was no statistical difference in the measurements of the inferior pole between the groups with anomalies and the control group, both in polyester resin endocasts and in 3D CT-scan reconstruction images, as well for the LIP in the resin endocasts. We observed statistical difference when comparing the LIP in the 3D CT-scan between HK and PUD (p= 0.003) and between HK and CG (p= 0.035). When we compared the polyester resin endocasts versus 3D CT-scan reconstruction images, analyzing only the lower pole, we observed statistical difference: in LIP (p= 0.006), LIICA (p= < 0.001) and length of major calyces between PUD groups (0.034).
Conclusions: In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the pyeloureteral duplication.

Palavras Chave ( separado por ; )

Horseshoe kidney; Pyeloureteral duplication; Kidney anatomy; Lower pole kidney anatomy; Three-dimensional endocasts