Introduction: This paper attempts to verify the anatomical veracity of the belief that in order to enter into a posterior calyx one must aim for the medial calyx during a percutaneous nephrolithotomy (PCNL). Methods: Volume rendered and maximum intensity projection reconstructions of normal pelvicalyceal systems were assessed in various rotational planes. An experienced urologist decided the appropriate access for PCNL in the upper, interpole and lower calyx on each side. The selected calyx was then viewed on anteroposterior sections to decide whether they were projecting laterally or medially. Results: Of the 508 calyces studied, the posterior calyx was projecting laterally in 72% and medially in 28%. In the upper calyx, the posterior calyx was projecting laterally in a majority of cases, 94% on the right and 89% on the left. In the right lower calyx, the posterior calyx was pointing laterally in 86%, whereas the distribution on the left was 64%. Conclusion: Our results refute the belief that the medial calyx is always synonymous with the lateral calyx.

Keywords:
Calyx, Percutaneous nephrolithotomy, Fluoroscopy, Volume rendered, Brodel type, Hodson type
1.
Wang K, Zhang P, Xu X, Fan M: Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a meta-analysis. Urol Int 2015;95:15-25.
2.
Zheng C, Xiong B, Wang H, Luo J, Zhang C, Wei W, Wang Y: Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal stones >2 cm: a meta-analysis. Urol Int 2014;93:417-424.
3.
Gupta M, Ost MC, Shah JB, McDougall EM, Smith AD: Chapter 46 - Percutaneous Management of the Upper Urinary Tract, ed 9. Campbell-Walsh Urology, 2007.
4.
Sengupta S, Donnellan S, Vincent JM, Webb DR: CT analysis of caliceal anatomy in the supine and prone positions. J Endourol 2000;14:555-557.
5.
Kaye KW, Reinke DB: Detailed caliceal anatomy for endourology. J Urol 1984;132:1085-1088.
6.
Brodel M: The intrinsic blood vessels of the kidney and their significance in nephrostomy. Hopkins Hosp Bull 1901;12:10.
7.
Hodson J: The lobar structure of the kidney. Br J Urol 1972;44:246-261.
8.
Miller J, Durack JC, Sorensen MD, Wang JH, Stoller ML: Renal calyceal anatomy characterization with 3-dimensional in vivo computerized tomography imaging. J Urol 2013;189:562-567.
9.
Park S, Pearle MS: Imaging for percutaneous renal access and management of renal calculi. Urol Clin North Am 2006;33:353-364.
10.
Matlaga BR, Shah OD, Zagoria RJ, et al: Computerized tomography guided access for percutaneous nephrostolithotomy. J Urol 2003;170:45-47.
11.
Andonian S, Scoffone CM, Louie MK, Gross AJ, Grabe M, Daels FP, Shah HN, de la Rosette JJ; CROES PCNL Study Group: Does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol 2013;27:24-28.
12.
Sinha M, Krishnappa P, Subudhi SK, Krishnamoorthy V: Supracostal percutaneous nephrolithotomy: a prospective comparative study. Indian J Urol 2016;32:45-49.
© 2016 S. Karger AG, Basel
2016
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