Ureteropelvic Junction Stenosis: Vascular Anatomical Background for Endopyelotomy

Abstract

To help endourologists perform endopyelotomy safely and efficiently with a reduced risk of vascular complications, we analyzed the vascular relationships to the ureteropelvic junction in 146, 3-dimensional endocasts of the kidney collecting system together with the intrarenal arteries and veins. There was a close relationship between a prominent vessel (artery and/or vein) and the anterior surface of the ureteropelvic junction in 65.1% of the cases, including the inferior segmental artery with a tributary of the renal vein in 45.2% and an artery or vein in 19.9%. In the remaining 34.9% of the cases the anterior surface of the ureteropelvic junction was free of vessels. There was a direct relationship between a prominent vessel (artery and/or vein) and the posterior surface of the ureteropelvic junction in 6.2% of the cases, including an artery and vein in 2.1%, and just an artery in 1.4%. In all cases (3.5%) of an artery crossing at the posterior surface of the ureteropelvic junction, this vessel was the posterior segmental artery (retropelvic artery). In 2.7% of the cases the relationship of the prominent vessel was just with a posterior tributary of the renal vein, and in 20.5% a vessel crossed lower than 1.5 cm. above the posterior surface of the ureteropelvic junction. Among these latter cases the vessel was an artery (posterior segmental artery) in 6.8%. In the remaining 73.3% of the cases the posterior surface was free of vessels up to 1.5 cm. above the ureteropelvic junction. Due to the anatomical findings, we advise that posterior and posterolateral incisions at the ureteropelvic junction be avoided, and that deep incision alongside the ureteropelvic junction stenotic wall be done only laterally.

Accessory or additional renal arteries show no relevant effects on the width of the upper urinary tract: a 64-slice multidetector CT study in 1072 patients with 2132 kidneys

“…Crossing vessels, which are thought to cause from 40% to over 50% of the extrinsic UPJ obstructions in adults [4,5], are located ventral more often than dorsal to the UPJ. These are usually normal vessels of the lower pole segment [4,[6][7][8][9], which can be divided into additional renal arteries arising from the aorta, and accessoric renal arteries arising from branches of the aorta [10,11]. The primary surgical therapy of choice is endoscopic endopyelotomy [12].…”

Intermediate veins in swine (Sus scrofa domestica) kidney: authors’ own anatomical classification

“…Hollinshead [4] notes, that veins in the renal sinus are usually located close to the ventral side of the renal pelvis, but he agrees with Merklin and Michels [8], that in 30% of cases, main venous vessels which are a tributary of the renal vein run close to the dorsal side of the renal pelvis. Sampaio [14][15][16][17][18] also mentions main dorsal tributaries of the renal vein in a human. In a swine all tributaries of the renal vein are located on the ventral side.…”

Evaluation of the Variant Anatomical Disposition of the Renal Hilar Structures in South Indian Adult Human Cadavers and Its Cinical Implications

“…Understanding the uretero-pelvic anatomy is very important, as any obstruction at its junction is considered to be the commonest form of an upper urinary tract obstruction [15,16]. Rouviere et al, [17] reported that, the 29-65% incidence of the cases which had presented with anomalous courses of the renal vessels which had crossed the renal pelvis, was caused by ureteropelvic obstructions.…”

“…A difficult hilar dissection results in the conversion of a laparoscopic operation to an open procedure [6]. With the presence of anomalous hilar structural arrangements, it is advised to make a lateral deep incision alongside the ureteropelvic junction, rather than approaching its anterior or posterior aspects during endopyelotomies [16]. The variations in the branching patterns of the renal vessels are critical issues and a challenging task for a radiologists who interpret renal angiograms and for the urologists who perform laparoscopies [20].…”