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Ureteropelvic junction stenosis: vascular anatomical background for endopyelotomy
1Department of Anatomy, State University of Rio de Janerio, Brazil.
Insights
Vascular anatomy near the ureteropelvic junction (UPJ) was studied in 146 kidney models. Most UPJs had anterior vessels; posterior vessels were less common, guiding safer endopyelotomy surgical approaches.
Area of Science:
- Urology
- Anatomy
- Surgical Innovation
Background:
- Endopyelotomy is a minimally invasive procedure for ureteropelvic junction obstruction.
- Vascular anomalies near the ureteropelvic junction (UPJ) pose a risk of bleeding during endopyelotomy.
- Detailed anatomical knowledge is crucial for improving surgical safety and efficacy.
Purpose of the Study:
- To meticulously analyze the vascular anatomy surrounding the ureteropelvic junction (UPJ).
- To identify the prevalence and location of arteries and veins relative to the UPJ.
- To provide anatomical guidance for reducing vascular complications during endopyelotomy.
Main Methods:
- Analysis of 146 three-dimensional endocasts of the kidney collecting system.
- Detailed mapping of intrarenal arteries and veins in relation to the UPJ.
- Quantification of vessel proximity to anterior and posterior surfaces of the UPJ.
Main Results:
- A prominent vessel was closely related to the anterior UPJ surface in 65.1% of cases.
- Vessels were present on the posterior UPJ surface in 6.2% of cases, with the posterior segmental artery noted in 3.5%.
- A significant portion (20.5%) had vessels crossing within 1.5 cm of the posterior UPJ.
Conclusions:
- Anterior surface vessels are common, necessitating careful dissection during endopyelotomy.
- Posterior and posterolateral approaches to the UPJ should be avoided due to potential vascular injury.
- Lateral incisions along the stenotic UPJ wall are recommended for safer surgical outcomes.
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.