Year : 2001 | Volume
: 17 | Issue : 2 | Page : 164--165
Multiple variations of renal vessels and ureter
Sampath Madhyastha, R Suresh, Ramesh Rao
Department ofAnatomy, Kasturba Medical College, Manipal, India
Department of Anatomy.,Kasturba Medical College, Manipal - 576 119
It is not very uncommon to find accessory renal artery (or arteries) or double ureter and a number of such cases have been reported. The various types of accessory renal arteries, their positions, method of entry to the kidney and its segmentation were studied extensively by David Sykes.  However, multiple variations in a single subject was not reported so far, with best of our knowledge.
During routine dissection it was observed in one of the male cadavers that the kidney presented a number of variations bilaterally. It was found that the right kidney had four (accessory) renal arteries and three renal veins. The hilum extending on to the anterior surface and presented double ureter.
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Madhyastha S, Suresh R, Rao R. Multiple variations of renal vessels and ureter.Indian J Urol 2001;17:164-165
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Madhyastha S, Suresh R, Rao R. Multiple variations of renal vessels and ureter. Indian J Urol [serial online] 2001 [cited 2022 Jun 28 ];17:164-165
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Accessory renal vessels were observed in about 40% individuals.  The single kidney with two ureters is also a known variation. The relations of these renal vessels and ureters to the kidney and various other structures are important in the renal transplant operations. Hence the relations of these renal vessels and double ureter are discussed.
Materials & Methods
During routine dissection it was observed in one of the male cadavers, the kidney presented a number of variations bilaterally.
The first and second right accessory renal arteries were arising close to each other immediately below the origin of superior mesentric artery. The upper artery (1-ARA) reached the anterior surface of the kidney above the hilum and was accompanied by a renal vein. The second right renal artery (2-ARA) entered the anterior surface (hilum extending till the middle of the anterior surface). This artery was also accompanied by a renal vein [Figure 1].
The third right renal artery (3-ARA) passed laterally and reached the kidney at hilum. This artery can be considered as normal artery because of its normal position. However, it is difficult to determine which was the main one, because all had a similar caliber. It was noted that the right testicular artery was arising from this artery. The fourth right renal artery (4-ARA) was arising from the aorta just above its bifurcation. This artery passed upwards and laterally and entered the kidney at its medial border; before entering the kidney it was divided into two branches. All these renal arteries passed in front of the inferior vena cava.
There were three renal veins (accessory renal veins). The upper two were accompanied by the corresponding arteries. The second renal vein received the right testicular vein. The third renal vein was a short pedicle accompanied by the fourth renal artery. This vein emerged at the medial border of the kidney.
There were two ureters. The upper ureter was arising from the anterior surface of the kidney above the hilum. It then descended along the medial margin of the kidney posterior to the accessory renal vessels. The lower ureter was arising from the anterior surface of the kidney at the hilum. Lower down both the ureters were joined to open into the urinary bladder at a single ostium.
Accessory renal arteries are common in 40% of individuals, usually arising from the aorta above or below the main renal artery. The variation in the number of arteries is because of persistence of lateral splanchnic arteries  or due to the persistence of blood supply from lower level than normal.  All the accessory renal arteries in the present case reached the kidney anterior to the inferior vena cava. This is because of the developmental reasons of the inferior vena cava. The right post-cardinal vein contributed mainly to form the post-renal segment of the inferior vena cava.  Accessory renal veins were the persistent mesonephric veins draining into the right subcardinal vein.
The double ureter in this case was due to the longitudinal splitting of single normal ureteric bud.  As ureteric bud grows cranially towards the metanephros its growing end becomes divided into two.
In all surgeries on the kidney it is necessary to locate the ureter and any anomalous vessels that reach the kidney at various points away from the hilum. The problem in the presence of accessory renal artery is to whether or not an accessory artery can be ligated and divided without causing damage to the kidney.
When there are two or more renal vessels, the vessels do not anastomose within the substance of the kidney. Each artery supplies a separate part of the kidney. Hence none of the multiple renal arteries can be regarded as accessory. Obstruction of any renal branch leads to cessation of function and death of that part of the kidney supplied by it.  Hence the term accessory is misleading.
According to David Sykes,  when there were many accessory renal arteries, the superior accessory artery is a separate segmental artery and the inferior accessory artery is a separate lower segmental artery.
In pyelostomy the incision to the renal pelvis should be made from posterior surface to avoid numerous branches of the renal arteries. Presence of accessory renal artery can be either a direct cause or an aggravating factor in the production of hydronephrosis. , Double ureter is more liable to infections, calculus or hydronephrosis.  Position of the ureter or ureters are important in case of hysterectomy.
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