Pelvi-ureteric junction obstruction related to crossing vessels: vascular anatomic variations and implication for surgical approaches

Abstract

Pelvi-ureteric junction obstruction corresponds to an impairment of urinary transport that can lead to renal dysfunction if not treated. Several mechanisms can cause the obstruction of the ureter including intrinsic factors or extrinsic factors such as the presence of crossing vessels. The treatment of the disease relies on surgical approaches, pyeloplasty being the standard reference. The technique consists in removing the pathologic ureteric segment and renal pelvis and transposing associated crossing vessels if present. The vascular anatomy of the pelvi-ureteric junction is complex and varies among individuals, and this can impact on the disease development and its surgical treatment. In this review, we summarize current knowledge on vascular anatomic variations in the pelvi-ureteric junction. Based on anatomic characteristics, we discuss implications for surgical approaches during pyeloplasty and vessel transposition.

The safety aspects of accepting living kidney donors with pelvi-ureteric junction dysfunction

“…Finally, they did not assess the degree of PUJ or related vascular anatomic variations, which have pivotal implications in surgical approaches [6]. More severe degrees of PUJ might have different outcomes.…”

Management of Accessory Renal Artery During Abdominal Aortic Aneurysm Repair

“…3 The presence of 2 additional arteries can also be observed. 3,4 The incidence of a duplication of the renal artery has been estimated between 23.2% and 26% and a triplication of the renal artery in 3% to 4.5% of cases. 5,6 The mean lengths of the first and second additional renal arteries have been estimated to be 4.5 and 3.8 cm on the right, 4.9 and 3.7 cm on the left.…”

“…1,2 A polar renal artery can originate from the abdominal artery or the renal artery to vascularize the hilum, the superior or the inferior pole. 3 The presence of 2 additional arteries can also be observed. 3,4 The incidence of a duplication of the renal artery has been estimated between 23.2% and 26% and a triplication of the renal artery in 3% to 4.5% of cases.…”

“…The mean diameters have been estimated to be, respectively, 0.4 and 0.3 (right side), 0.3 and 0.3 cm (left side). 3,5,6 These anatomic variations may potentially challenge the management of abdominal aortic aneurysm (AAA) repair. Indeed, in case of a juxtarenal or thoracoabdominal aneurysm involving the renal arteries, the question arises whether the polar renal arteries should be spared or covered by the device.…”

“…The mean diameters have been estimated to be, respectively, 0.4 and 0.3 (right side), 0.3 and 0.3 cm (left side). 3,5,6…”