None of the patients had a stent within six weeks of their operative procedure and all patients had a contrast-enhanced computed tomography angiography, or magnetic resonance imaging to detect the crossing vessel. Of the 10 patients, 6 were identified as having a crossing vessel by preoperative imaging. All six patients had a crossing artery and 3 also had a crossing vein at the time of their surgical procedure. In these 10 patients, after mobilization of the UPJ or the crossing vessel an intra-operative Whitaker test was performed using a laparoscopic 22-gauge needle to puncture the renal pelvis and infuse saline at a rate of 10 mL/min. Bladder and renal pelvic pressures were measured simultaneously. After complete mobilization of the UPJ and the crossing vessel, if present, the Whitaker test was then repeated and a dismembered pyeloplasty performed. No significant change was found in the renal pelvic pressure after mobilizing the renal pelvis in patients without a crossing vessel. However, in those patients with crossing vessels the mean renal pelvic pressure significantly declined after the vessel was dissected and repositioned (25.6 + 4.5 cm H2O to 9.5 + 6.6 cm H2O, P = 0.006). In this albeit small group of UPJ obstruction patients extrinsic vascular compression appears to contribute to the underlying functional obstruction. While some may argue that dissection of the vessel and transposition away from the UPJ may be the only treatment necessary it is my clinical experience that also performing the dismembered pyeloplasty is important to resolving the obstructive process.

Stern JM, Park S, Anderson JK, Landman J, Pearle M, Cadeddu JA

Urology. 69 (6):1022-1024, June 2007doi:10.1016/j.urology.2007.02.055

UroToday.com Laproscopic and Robotic Section

Written by Elspeth M. McDougall, MD, a Contributing Editor with UroToday.

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