Que es la pelvis renal yahoo dating

expanding indications of flexible ureteroscopy in renal and ureteral stones

que es la pelvis renal yahoo dating

E-mail: [email protected] There are very few cases of clear cell renal cell carcinoma with metastases to the Publication date (electronic): 27 October A CT scan of the chest, abdomen, and pelvis done after the diagnosis of. circolazione renale yahoo dating This guy that I'm talking to know I've known for about 3 years Prenatal ultrasound shows dilated renal pelvis?. Tel: +; Email: [email protected];[email protected] 14July, ; Accepted Date: 07August, ; Published Date: 14 August,

Abstract A comprehensive knowledge of the wide range of variations of renal vasculature and renal pelvis is mandatory to the anatomists for a better understanding of the embryology. It remains as the key issue in determining the technical feasibility of various endourologic procedures and innumerable intervention techniques besides kidney retrievals for transplantation. In the present case the duplex kidney showed lobulations on the anterior surface just adjacent to the hilar region.

The midlateral portion of the convex lateral border of the kidney showed a small focal bulge —dromedary hump. At the hilum reversed anterio-posterior disposition of renal vasculature with anteriorly placed renal artery which bifurcated into two upper and lower anterior segmental branches.

The renal vein formed by large tributaries arising from the hilum running towards the inferior vena cava. The renal pelvis was most posteriorly placed which showed a double pelvis. The upper pelvis was seen arising behind the renal vein and the lower pelvis arising inferomedial to the lower anterior segmental artery. Both the pelvises were seen uniting medial to the lower part of hilum and continued as a single ureter which opened into the bladder.

The thorough knowledge of these anatomical variations is necessary to avoid iatrogenic injuries and enable the surgeon and radiologists approach unusual situations with confidence rather than surprise. Keywords double pelvis,lobulations,segmental branches Introduction The kidneys are paired reddish brown retroperitoneal organs lying in the paravertebral gutters of posterior abdominal wall. Multiple lobulations are seen throughout the fetal life [ 1 ]. Most of them disappear during the first year of birth but varying degrees of lobulations may persist in the adult life It is not unusual to see a focal bulge in the mid lateral contour of the kidney, refered to as dromedary hump.

Atypical twin renal arteries with altered hilar anatomy

It is a normal variation occurring due to the downward pressure of spleen on the left side [ 2 ]. The renal vascular pedicle classically described as single artery, larger vein lying anterior to the artery entering via the hilum.

Behind them lies the renal pelvis, which is the collecting system of the kidney. The renal artery typically divides into a more constant posterior division and anterior division. The anterior division shows apical, upper, middle, and lower anterior segmental branches.

All the segmental arteries are end arteries supplying their respective segments. A duplex kidney is one that has two separate pelvicalyceal systems. It has an upper pole and lower pole the ureters may join at any point. If they join at level of uretero-pelvic junction the configuration is termed bifid system. If the urters join more distally or proximal to the bladder called bifid ureters [ 2 ].

The kidney and ureter develop in the mesoderm on the dorsal wall of the coelomic cavity. The distal part of the duct of the transient pronephros receives tubules of mesonephros to develop and termed the mesonephric duct. A diverticulum appears at lower end of mesonephric duct, which develops into the metanephric duct or ureteric bud. On the the top of the ureteric bud a cap of tissue differentiates to form the metanephros which develops into the definitive kidney [ 3 ].

The ureteric bud arises from the mesonephric duct around fifth week of intrauterine life [ 4 ]. The branching and growth of the ureteric bud is stimulated by the glial derived neurotropic factor GDNF and scatter factor hepatocyte growth factor which are produced by the transcription factor WT1 expressed by the mesenchyme. The ureteric bud forms the ureter which dialates at the upper end to form the major calyces and in turn divides to form the minor calyces and collecting tubules [ 6 ].

Case Report The altered hilar anatomy with double pelvis was observed in the left duplex kidney of a year-old female cadaver during the routine dissection hours for first year M. The specimen was a lobulated duplex left kidney, which showed prominent lobulation on the anterior surface just adjacent to the hilar region, also the mid-lateral portion of the convex lateral border showed a small focal bulge — the dromedary hump Figure 1.

que es la pelvis renal yahoo dating

The perihilar region showed that the renal vasculature was reversed in its antero-posterior disposition Figure 1. The renal artery was the 1st structure encountered with two anterior segmental branches, the upper branch and lower branch Figure 1.

The renal vein which was seen behind the artery was formed by two tributaries as superior and inferior. They were arising from the hilum and running towards the inferior vena cava. A left gonadal vein was seen joining the left renal vein Figure 2.

Atypical twin renal arteries with altered hilar anatomy

The inferior formative tributary is seen overlapped by the lower segmental anterior branch of renal artery. When viewed medially, after merging with each other the renal vein was seen larger and was lying anterior to the renal artery and overlapping it.

Near its termination in males it is crossed by the vas deferens and by the uterine artery in females. The ureter passes obliquely through the wall of the bladder for about 1. Anatomical variations of ureters and their relationship to surrounding structures are therefore of particular importance from an academic point of view, a surgical perspective, radiological examinations and treatment to preserve renal functions.

A duplex kidney with dromedary hump showing altered hilar anatomy

A male cadaver of approximately 40 years showed bilateral double ureters. In this case, the ureters originated from the upper and lower renal poles from the right and left kidneys Figure 1.

On both sides the ureters opened separately to the urinary bladder. In addition, we also detected in the same cadaver a bilateral lower polar accessory renal arteries and a right accessory renal vein Figure 2. The lower polar accessory renal arteries took origin from the abdominal aorta to supply the respective poles of right and left kidneys. The right accessory renal vein opened directly into the inferior vena cava.

A duplex kidney with dromedary hump showing altered hilar anatomy

Left and right kidneys showing double ureters bilaterally opening into urinary bladder. Left and right kidneys showing renal vessels and accessory vessels bilaterally. Incomplete duplication of ureter is known as bifid ureter, this kind of variation may be formed due to some error or disturbance in development of the ureteric bud which arises from the mesonephric duct around the 5th week [ 2 ].

Double ureter may be found either bilaterally or unilaterally, more commonly the left.

The ureter may join before reaching the bladder or remain separate and enter the bladder on the same side at two distinct points [ 5 ]. Incomplete ureteral duplication, in which one common ureter enters the bladder, is rarely clinically significant.

Alternatively, complete ureteral duplication, in which 2 ureters ipsilaterally enter the urinary bladder, has a propensity for vesicoureteral reflux into the lower pole and obstruction of the upper pole, which can be problematic [ 6 ]. Duplex collecting systems can be associated with a variety of congenital genitourinary tract anomalies [ 7 ]. Most patients having double ureters are asymptomatic, with genitourinary tract anomalies being detected incidentally on imaging studies performed for other reasons.

Symptomatic patients usually have complete ureteric duplication in which the ureters are prone to developing obstruction, reflux and infection. Ureteropelvic obstruction is more common when a duplex kidney exists and can be inherited in an autosomal dominant pattern [ 8 ].

Cases of double pelvis and double ureters may be found by chance on radiological investigation of the urinary tract. They are more liable to become infected or to be the seat of calculus formation than a normal ureter. The cause is a premature division of the ureteric bud near its termination [ 910 ]. The duplex ureters derive from two ureteric buds arising from the mesonephric duct. They are contained in a single fascia sheath and may fuse at any point along their course or may be separated until they insert through separate ureteric orifices into the urinary bladder.

Care must be taken not to compromise the blood supply of the second ureter when excising or reimplanting a single ureter of a duplex [ 2 ]. The ureter from the upper pole of the kidney inserts more medially and caudally in the urinary bladder than the ureter from the lower pole. This reflects the embryological development of the ureter where by the ureteric bud which is initially more proximal on the mesonephric duct has a shorter time to be pulled cranially in the urinary bladder and so it inserts more distally in the mature urinary bladder.

The ureter from the lower pole has a shorter intramural course than the longer ureter and is prone to reflux [ 2 ]. Lower division of the ureteric bud produce double ureters, which is due to premature division of the ureteric bud.

que es la pelvis renal yahoo dating

The two ureters may branch from a single distal segment or they may open separately into the urinary bladder. In the later case, as dilatation of the distal ureteric segments incorporates them into the urinary bladder wall, rotation about each other results in the lower ureteric orifice draining the lower pole of the kidney [ 10 ].

Bilateral duplex ureters occur in approximately 1 in cases [ 2 ]. Knowledge about the anatomical variations of the renal collecting system is of great importance for surgical approaches and radiologic and other evaluative methods, like cystoscopy and retrograde pyelography.