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Endopyelotomy has become an accepted mode of treatment for primary and secondary ureteropelvic junction (UPJ) obstruction, but a 15% to 30% failure rate persists. The presence of crossing vessels at the UPJ has been implicated as a common cause of complications, failures, and recurrences. In the past, renal angiography was necessary to identify crossing vessels. We have utilized endoluminal ultrasonography to identify crossing vessels at the UPJ and to guide endoscopic incisional techniques. Previously, whenever crossing vessels were identified that could not be safely avoided during endopyelotomy, we had recommended dismembered pyeloplasty, an open surgical procedure with a long recovery time. We report our experience with laparoscopic division of crossing vessels in two patients, one with a symptomatic horseshoe kidney. Each patient had a large crossing vessel identified by endoluminal ultrasonography; consequently, endopyelotomy was abandoned. The location and distribution of the vessels were then delineated by angiography. The aberrant vessels were dissected free and divided laparoscopically. The patients returned to work within 1 week. Follow-up diuretic renal scans showed complete resolution of obstruction (T1/2 < 10 minutes) in one patient; no change was noted in the patient with a horseshoe kidney. Both patients have remained free of symptoms and normotensive for more than 12 months. Laparoscopic division of crossing vessels may play a role in the treatment of patients with extrinsic ureteral obstruction from aberrant vessels.

Deterioration of the germinal epithelium of the testis is a known sequela of spinal cord injury (SCI) that may influence the outcome of male reproductive rehabilitation efforts. Quantitative testicular biopsy, currently regarded as the standard of assessing the integrity of spermatogenesis, has not gained wide spread clinical use because of its invasive nature and relative technical complex ity. Alternatively, aspiration DNA flow cytometry analysis of the testis has offered a potential method of spermatogenic assessment that meets both the requirements of simplicity and objectivity. The objective of this study is to determine the capability of flow cytometry to assess spermatogenesis following SCI. Eleven SCI men underwent incisional testicular biopsy with the specimen simultaneously submitted for quantitative evaluation of the germinal epithelium by both quantitative histometry and DNA flow cytometry. The haploid percen tage of cells showed highly significant levels of correlation with key micrometric parameters of the quantitative testicular biopsy: spermatid/tubule (p < 0.002) and the spermatid/Sertoli cell ratio (p < 0.0005). Since tissue procurement is accomplished less invasively for flow cytometry analysis, we recommend this method as the modality of assuring integrity of the germinal epithelium in candidates for reproductive rehabilitation.

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