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Differences between intrinsic and extrinsic ureteropelvic junction obstruction related to crossing vessels: histology

V Ellerkamp1, R R Kurth2, E Schmid3

  • 1Department for Pediatric Surgery and Pediatric Urology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, Tuebingen, 72076, Germany. mail@verenaellerkamp.de.

World Journal of Urology
|July 30, 2015
PubMed

Insights

Extrinsic ureteropelvic junction obstruction (UPJO) due to crossing vessels (CVs) in children is rare. Histological analysis showed no significant differences compared to intrinsic UPJO, with excellent functional recovery after surgery.

Area of Science:

  • Pediatric Urology
  • Surgical Pathology
  • Renal Physiology

Background:

  • Ureteropelvic junction obstruction (UPJO) in children is predominantly caused by intrinsic factors (IUPJO).
  • Extrinsic UPJO, often caused by crossing vessels (CVs), is less common.
  • Understanding the underlying pathology of extrinsic UPJO is crucial for effective treatment.

Purpose of the Study:

  • To compare the histological characteristics of UPJO caused by crossing vessels (CV) with intrinsic UPJO (IUPJO) in children.
  • To evaluate the impact of CVs on differential renal function (DRF) and surgical outcomes.
  • To determine if histological differences influence functional recovery after pyeloplasty.

Main Methods:

  • Retrospective review of pediatric UPJO cases (2004-2011).
  • Analysis of surgical data, ultrasound, renal scans (DRF), and pathology reports.
  • Blinded histological comparison of CV and IUPJO specimens, including Masson's trichrome staining for fibrosis, hypertrophy, and inflammation.

Main Results:

  • 39 of 139 UPJO cases were associated with CVs.
  • CV patients were older at surgery and more frequently had DRF below 40%.
  • No significant histological differences were found between CV and IUPJO specimens; however, higher muscular hypertrophy correlated with lower preoperative DRF in CV cases. Functional recovery after pyeloplasty was excellent in both groups.

Conclusions:

  • No significant histological differences exist between CV-associated UPJO and IUPJO in children.
  • Surgical correction of the UPJ is essential for excellent functional recovery in pediatric patients with CV-associated UPJO.
  • Further research may explore specific histological markers or biomechanical properties related to CVs.
Abstract

Keywords:
ChildCrossing vesselsHydronephrosisUreteral obstruction

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