A STUDY OF HUMAN RENAL PELVICALYCEAL SYSTEM IN RELATION TO THE BRANCHES OF RENAL ARTERIES

Introduction: A thorough anatomical knowledge on the patterns of pelvicalyceal system and its relation to the renal segmental arteries is of paramount importance in endourological procedures. Aim: To study the variations in the pattern of arrangement of major calices, segmental arteries and their relation to each other. Method: 100 dissection specimens (70 adult, 30 foetuses) and 50 endocasts were studied at a tertiary center in northern Kerala. Results: The major calyces were arranged in three patterns, tricaliceal (Adults- 44.17%; Foetus-30%), bicaliceal (Adults- 24.17%; Foetus-26.67%), multicaliceal (Adults- 25.83%; Foetus- 40%) and rest belonging to none of the above. The primary division of renal artery (RA) was anterior-posterior (92%) and upper-lower (8%). Anterior division showed a preponderance of type (TY) 2 among the 8 types. Apical segmental artery (SA) was divided into 6 types, with 50% showing TY1 pattern. 62% showed TY1 of upper SA (among 3 types) and 84% of TY1 of lower SA (total-4 types). Middle SA showed 54% TY1 among 4 types. Posterior SA divided in magistral (62%), bifurcating (30%), cruciate (8%) patterns. Superior calyces were related to anterior and posterior branches in 88%, anterior alone in 10% and posterior alone in 2%; mid-zone to anterior division only; inferior pole to branches of lower SA. Dorsal kidney was related to posterior SA which was related to upper infundibulum (60%) or crossed middle posterior surface of pelvis (40%). Conclusion: Numerous variations in patterns of calyces, SAs and their relation to each other were observed, which could not be discerned from studying the external surface of the kidney. This emphasizes the importance of pre-operative angiography and IVU prior to any endourological intervention.