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Intrarenal access: 3-dimensional anatomical study
F J Sampaio1, J F Zanier, A H Aragão
1Department of Anatomy, State University of Rio de Janeiro, Brazil.
The Journal of Urology
|December 1, 1992
Summary
Puncturing the kidney collecting system via a caliceal fornix is safe, unlike infundibulum or renal pelvis access which carry high risks of vascular injury. This finding guides safer renal access techniques.
Area of Science:
- Urology
- Nephrology
- Anatomy
Background:
- Percutaneous access to the kidney collecting system is crucial for various urological interventions.
- Identifying safe puncture routes is essential to minimize complications like vascular injury.
Purpose of the Study:
- To determine the optimal and safest anatomical route for puncturing the kidney collecting system.
- To evaluate the incidence of vascular lesions associated with different renal puncture techniques.
Main Methods:
- Creation of 3D polyester resin endocasts of pelvicaliceal systems and intrarenal vessels from 62 kidneys.
- Simulated punctures at superior pole, mid-kidney, inferior pole, and renal pelvis under radioscopy.
- Analysis of needle tracts and vascular damage on the endocasts after acid corrosion.
Main Results:
- Punctures through an infundibulum resulted in a high percentage of vascular lesions and should be avoided.
- Renal pelvis puncture also demonstrated a high risk of complications.
- Puncture through a fornix of a calix was consistently safe, irrespective of the kidney region targeted.
Conclusions:
- Accessing the kidney collecting system through a fornix of a calix is the safest method, minimizing vascular damage.
- Infundibulum and renal pelvis punctures are associated with significant risks and should be avoided for renal access.