Vessels Around the Ureteropelvic Junction: Significance and Imaging by Conventional Radiology

Abstract

We studied the influence of vessels crossing the ureteropelvic junction and of the grade of hydronephrosis in 86 patients who underwent endoureteropyelotomy. With a follow-up ranging from 1 to 12 years, the presence of crossing vessels had a significant negative influence on the outcome and recurrence rate of the procedure. The success rate was 82% when no vessels were present but only 33% when crossing vessels were documented. In 13 of 15 failures (87%), a crossing vessel was found at open pyeloplasty. The degree of hydronephrosis was a less potent detrimental factor, with an 81% success rate in low-grade and 54% in high-grade hydronephrosis. The best results (90% success) were obtained in patients with no crossing vessels and low-grade hydronephrosis and the worst (30% success) in those with high-grade hydronephrosis in the presence of crossing vessels. Selection of patients according to those prognostic factors is recommended. Conventional intravenous urographic imaging techniques proved insufficient, and only angiography provided diagnostic accuracy; less-invasive methods are desirable.

Vascular Renal Anatomy and the Ureteropelvic Junction: Preoperative Multidetector CT Scanning with Split-Bolus Injection as a Predictor of Laparoscopic Findings

“…When adjacent to an inferior-pole artery, its presence does not modify the surgical procedure, and therefore its detection is less crucial. 2,7 In our study, we missed seven veins in the crossing pedicle, but in the only case with an isolated inferior polar vein, the aberrant vessel was identified on MDCT. Some authors have argued that arteries can theoretically be distinguished from veins using a dual-phase technique and small-interval reconstruction.…”

“…Although some reports claim that crossing vessels have been implicated in UPJ obstruction, these vessels more commonly aggravate rather than cause the obstruction. [2][3][4][5][6][7][8] Computed tomography scanning is the only technique that can provide all the necessary information in a single examination.…”

“…Highgrade hydronephrosis, poor renal function, high insertion of the ureter, and the presence of a crossing vessel are prognostic of endopyelotomy failure. 2,7 A clear preoperative understanding of the patient's renal anatomy is of great value to urologists. Previous anatomic investigations have shown that vessels have a close relation to the UPJ in approximately 75% of patients with the syndrome.…”

“…Moreover, most of the remaining patients have high-grade hydronephrosis, high insertion of the ureter, or renal stones, all of which are prognostic of endopyelotomy failure. 7 Because of these factors, most of the patients in our in-SAUER ET AL. 2 stitution undergo robotic laparoscopic surgery.…”

“…It is not widely used at present. 2,7 Magnetic resonance angiography can be used to depict the renal vasculature. Using DSA as the reference standard, Bakker and collaborators 17 identified 21 of 22 accessory renal arteries and Korst et al 18 identified 13 of 17.…”