DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20213929

Anatomical study on variable disposition of structures in the renal hilum

Pooja Dawani, Vandana Mehta, Amandeep Kaur

Abstract


Background: The hilum is a deep vertical fissure present anteromedially in the kidney, and contains renal vessels and pelvis. Due to advancements in imaging techniques; nephron sparing surgeries like laparoscopic partial nephrectomy have become more common. In these procedures, only specific branch of renal artery, and tributary of renal vein are ligated in the renal hilum. This requires adequate skill of the surgeon as the structures are crowded in the renal hilum. The knowledge of arrangement of renal hilar structures is also important for radiologists to correctly interpret renal angiograms and other radiological scans.

Methods: The present study was conducted in the department of anatomy, Vardhman Mahavir medical college, New Delhi on 64 kidneys derived from embalmed human cadavers. The renal hilum was dissected and the sequence of structures from anterior to posterior direction was noted.

Results: The kidneys were classified in 6 patterns, with the classical pattern (renal vein, artery and pelvis from anterior to posterior) observed in 37.5% cases only. Remaining 62.5% cases exhibited variations, of which the pattern 2 (V-A1-P-A2) was seen in maximum cases (26.5%).

Conclusions: The classical pattern described in anatomical textbooks is not the only pattern of arrangement of renal hilar structures. Instead, variant patterns are commonly encountered. The present study attempts to elucidate the variant anatomy of the renal hilar region to help radiologists and surgeons in proper diagnosis and treatment.


Keywords


Renal hilum, Renal vessels, Renal pelvis, Laparoscopic, Nephrectomy

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References


Guzzo TJ, TorigianDA. Kidney and ureter. In: Standring S eds. Gray’s anatomy: the anatomical basis of clinical practice. 41st ed. Philadelphia: Elsevier; 2016:1237.

Moore K, Dalley AF, Agur AMR. Kidneys, ureters and suprarenal glands. In: Clinically oriented anatomy. 8th ed. Philadelphia: Wolters Kluwer; 2010:292.

Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7(9): 735-40.

Desai MM, Gill IS. Laparoscopic partial nephrectomy for tumour: current status at the Cleveland Clinic. BJU Int. 2005;95(2):41-5.

Sampaio FJ, Favorito LA. Endopyelotomy. Anatomical study of the vascular relationships to ureteropelvic junction. J Urol. 1991;97(2):73-7.

Kumar N, Guru A, Aswini AP, Shetty SD, Satheesha NB, Narendra P. Evolution of the variant anatomical disposition of the renal hilar structures in south Indian adult human cadavers and its clinical implications. J Clin Diagn Res. 2013;7(8):1543-46.

Trivedi S, Athavale S, Kotgiriwar S. Normal and variant anatomy of renal hilar structures and its clinical significance. Int J Morphol. 2011;29(4):1379-83.

Divya C, Ashwini NS, Swaroop Raj BV, Venkateshu KV. Sudy of arrangement of renal hilar structures in human cadavers. Int J Anat Res. 2018;6(1):4890-96.

Sadler TW. Cardiovascular system. In: Langman’s medical embryology. 12th ed. Philadelphia: Wolters Kluwer; 2012:193.

Gill IS, Colombo JR, Frank I, Moinzedah A, Kaouk J, Desai M. Laparoscopic partial nephrectomy for hilum tumors. J Urol. 2005;174(3):850-4.

Latouff JB, Beri AD, Ambros OF, Grull M, Leeb K, Janetschek G. Laparoscopic partial nephrectomy for hilartumors technique and results. Eur Urol. 2008;54(2):409-16.

Rapp DE, Orvieto MA, Gerber GS, Johnston WK, Wolf JS, Shalhav AL. En bloc stapling of renal hilum during laparoscopic nephrectomy and nephroureterec tomy. Urol. 2004;64(4):655- 9.

Sampaio FJ. The dilemma of crossing vessels at the ureteropelvic junction: precise anatomic study. J Endourol. 1996;10(5):411-5.

Sampaio FJ. Vascular anatomy at the ureteropelvic junction. Urol Clin North Am. 1998;25(2):251-8.

Sampaio FJ, Aragão AH. Anatomical relationship between the renal venous arrangement and the kidney collecting system. J Urol. 1990;144(5):1089-93.

Snyder HM, Lebowitz RL, Colodny AH, Bauer SB, Retik AB. Ureteropelvic junction in children. Urol Clin North Am. 1980;7:273-90.

Rouviere O, Lyonnet D, Berger P, Pangaud C, Gelet A, Martin X. Ureteropelvic junction obstruction: Use of helical CT for preoperative assessment: comparison with intra-arterial angiography. Radiol. 1999;213:668-73.

Barnett JS, Stephens FD. The role of the lower segmental vessel in the aetiology of hydronephrosis. Aus NZ J Surg. 1962;31:201-13.