ANOMALY OF COLLECTING DUCT

1. Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai
Anomaly of the collecting duct
1

2. Moderators:
Professors:
 Prof. Dr. G. Sivasankar, M.S., M.Ch.,
 Prof. Dr.A. Senthilvel, M.S., M.Ch.,
Asst Professors:
 Dr. J. Sivabalan, M.S., M.Ch.,
 Dr. R. Bhargavi, M.S., M.Ch.,
 Dr. S. Raju, M.S., M.Ch.,
 Dr. K. Muthurathinam, M.S., M.Ch.,
 Dr. D.Tamilselvan, M.S., M.Ch.,
 Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai.
2

3. Anomalies
 Calyceal Diverticulum
 Hydrocalycosis
 Megacalycosis
 Unipapillary Kidney
 Extrarenal Calyces
 Anomalous Calyx
 Infundibulopelvic Stenosis
3 Dept of Urology, GRH and KMC, Chennai.

4. Calyceal Diverticulum
 cystic cavity in renal parenchyma lined by
transitional epithelium
 Communicates with a calyx or the renal pelvis
4 Dept of Urology, GRH and KMC, Chennai.

5. Etiology
 Persistence of ureteral branches of the third and fourth
generation
 Cortical abscess,
 infundibular obstruction
 Vesicoureteral reflux
 Spasm of the sphincters of minor calyx
5 Dept of Urology, GRH and KMC, Chennai.

6. types
 type I--adjacent to an upper or, occasionally, a lower pole
calyx
 Type II– LARGER communicate with the renal pelvis
6 Dept of Urology, GRH and KMC, Chennai.

7. Symptom/complication
STONE FORMATION
 Hematuria
 pain
 UTI
STASIS
 Infection
 Milk of calcium
7 Dept of Urology, GRH and KMC, Chennai.

8. investigations
 USG
 CECT
 MR-UROGRAPHY
8 Dept of Urology, GRH and KMC, Chennai.

9. INDICATIONS FOR MANAGEMENT
 enlargement of the diverticulum
 pain
 Infection
 abscess formation
 Urosepsis
 symptomatic calculus
9 Dept of Urology, GRH and KMC, Chennai.

10. MANAGEMENT
 Marsupialization of the diverticulum
 fulguration of the epithelial lining
 Percutaneous ablation of the communication
10 Dept of Urology, GRH and KMC, Chennai.

11. Hydrocalycosis
 Hydrocalycosis is cystic
dilation of a major
Calyx- renal pelvis
 ETIOLOGY- obstruction
of infundibulum
• VESSELS
• SCAR
• ACHALASIA
11 Dept of Urology, GRH and KMC, Chennai.

12.  SYMPTOMES—flank pain, hematuria, UTI
 DDs—
➢ multiple dilated calyces secondary to ureteral
obstruction
➢ Calyceal clubbing due to infection
➢ medullary necrosis
➢ renal tuberculosis
➢ large calyceal diverticulum
➢ megacalycosis.
12 Dept of Urology, GRH and KMC, Chennai.

13. management
 Dismembered infundibulopyeloplasty.
 Intubated infundibulotomy
 partial nephrectomy
13 Dept of Urology, GRH and KMC, Chennai.

14. Megacalycosis
 Megacalycosis -
nonobstructive
enlargement of calyces due
to malformation of the
renal papillae
 Features
➢ increased number of
calyces
➢ Normal pelvis
➢ Underdeveloped medulla
➢ Normal cortical thickness
➢ Normal renal function.
14 Dept of Urology, GRH and KMC, Chennai.

15. Etiology
 delay in the recanalization of the upper ureter
 transient obstruction when the glomeruli start producing
urine
 fetal calyces dilate and retain their obstructed appearance
 SYMPTOMES-Presents with hematuria due to calculi
15 Dept of Urology, GRH and KMC, Chennai.

16. DD S
 Obstruction
 Post obstructive atropy
 Reflux
16 Dept of Urology, GRH and KMC, Chennai.

17. IVP
 POLYGONAL shape
calyces
 Multifaceted
 Arranged as mosaic pattern
 More than 16 calyces
17 Dept of Urology, GRH and KMC, Chennai.

18. USG
 Sagittal ultrasonogram
dilated calyces and normal-
appearing pyramids
18 Dept of Urology, GRH and KMC, Chennai.

19. Diagnosis
 Diagnosed prenatally
 routine investigations for other conditions
 Diuretic renogram - washout of the contrast
 Associated - ipsilateral segmental megaureter
 Long term follow up no progression.
19 Dept of Urology, GRH and KMC, Chennai.

20. Unipapillary Kidney
 Features—
➢ The solitary calyx drains a ridge like papilla
➢ Nephrons attach to fewer collecting tubules drain directly
into papllia
➢ Smaller kidney
➢ Other kidney may be absent
➢ Associated with -megaureter, reflux, or ectopic insertion
20 Dept of Urology, GRH and KMC, Chennai.

21. UNIPAPILLARY KIDNEY
21 Dept of Urology, GRH and KMC, Chennai.

22. Pathogenesis
 Etiology –
➢ Failure of progressive branching after the first three to five
generations of UB
22 Dept of Urology, GRH and KMC, Chennai.

23. Extrarenal Calyces
 major calyces and the renal pelvis are outside the
parenchyma of the kidney
 Discoid kidney
 Blunted calyces
 Anomalous renal vessels
 Associated with ectopic and horse shoe kidney
23 Dept of Urology, GRH and KMC, Chennai.

24. Etiology
 Slow development of nephrogenic anlage
 Rapidly developing UB
 abnormal coalescence of the collecting system with the
nephrogenic mass
24 Dept of Urology, GRH and KMC, Chennai.

25. Anomalous Calyx (Pseudotumor of the
Kidney)
 mass, between the
infundibula of the
upper and middle
calyces- hypertrophied
column of Bertin
 Normal calyces
 Compress the pelvis
 Normal uptake of
isotope
25 Dept of Urology, GRH and KMC, Chennai.

26. Infundibulopelvic Stenosis
 Caused due to extensive dysgenesis of the pyelocalyceal
system
 associated with vesicoureteral reflux, suggesting an
abnormality of the entire UB.
 Function is usually normal.
26 Dept of Urology, GRH and KMC, Chennai.

27. 27 Dept of Urology, GRH and KMC, Chennai.

28. Extrarenal Pelvis
 Extrarenal pelvis refers
to the presence of the renal
pelvis outside the confines
of therenal hilum(2/3)
 It is a normal variant that
is found in 10% of the
population
28 Dept of Urology, GRH and KMC, Chennai.

29. Extrarenal Pelvis
 clinical importance only when drainage is impaired and may
be associated with malposition and malrotation that
predispose
➢ urinary stasis
➢ infection
➢ calculous disease.
29 Dept of Urology, GRH and KMC, Chennai.

30. Bifid Pelvis
 10% of normal renal
pelves are bifid
 Incomplete duplication and
a bifid pelvis—YOYO
effect
 Infrequently cause flank
pain and UTI
30 Dept of Urology, GRH and KMC, Chennai.

31.  THANK YOU
31 Dept of Urology, GRH and KMC, Chennai.