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Pelviureteric Junction Obstruction with Crossing Lower Polar Vessel: Indicators of Preoperative Diagnosis

INTRODUCTION: A crossing lower polar vessel (CLPV) is found in 11%–20% of children of pelviureteric junction obstruction (PUJO). Preoperative imaging (Doppler or magnetic resonance angiography (MRA)) may help but does not form a part of routine diagnostic workup. An attempt has been made here to eva...

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Autores principales: Gupta, Alisha, Dhua, Anjan, Agarwala, Sandeep, Bhatnagar, Veereshwar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042171/
https://www.ncbi.nlm.nih.gov/pubmed/30050259
http://dx.doi.org/10.4103/jiaps.JIAPS_207_17
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author Gupta, Alisha
Dhua, Anjan
Agarwala, Sandeep
Bhatnagar, Veereshwar
author_facet Gupta, Alisha
Dhua, Anjan
Agarwala, Sandeep
Bhatnagar, Veereshwar
author_sort Gupta, Alisha
collection PubMed
description INTRODUCTION: A crossing lower polar vessel (CLPV) is found in 11%–20% of children of pelviureteric junction obstruction (PUJO). Preoperative imaging (Doppler or magnetic resonance angiography (MRA)) may help but does not form a part of routine diagnostic workup. An attempt has been made here to evaluate clinical and imaging features (ultrasound and renal dynamic scan [RDS]) in children of PUJO with CLPV and define variables that could provide a diagnostic clue to its presence. MATERIALS AND METHODS: Records of children having PUJO with CLPV over 10 years (2006–2015) were reviewed retrospectively. Their demographic profile, clinical presentation, imaging features, management, and outcomes were evaluated. RESULTS: Of 372 children with PUJO, 21 (5.6%) had a CLPV. Median age at presentation was 7 years (range 4 months–11 years). Presenting features included pain (66.6%), urinary tract infection (14.3%), antenatally diagnosed fetal hydronephrosis (14.3%) and lump (4.8%). All had an obstructive drainage on RDS and mean split renal function (SRF) of the affected kidney was 32.5% ± 15.65%. The majority had mild-moderate hydronephrosis with intrarenal pelvis. None of the ultrasound images suggested the presence of a CLPV. Diagnosis of a CLPV was made intraoperatively in all. Dismembered pyeloplasty anterior to the vessel was done in the majority (80.9%). Mean SRF on postoperative RDS improved to 36.6% ±17.76% with nonobstructive drainage. All were asymptomatic at a mean follow-up of 34.5 ± 17.5 months (range 2–56 months). CONCLUSIONS: Pain is the predominant presenting feature in these patients who present at an older age. Despite older age at presentation, these patients have well-preserved renal function and mild hydronephrosis. No specific RDS or ultrasound findings can predict the presence of a CLPV. As the incidence of CLPV is <10% and management is essentially same as PUJO with intrinsic obstruction, preoperative Doppler or MRA are extraneous.
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spelling pubmed-60421712018-07-26 Pelviureteric Junction Obstruction with Crossing Lower Polar Vessel: Indicators of Preoperative Diagnosis Gupta, Alisha Dhua, Anjan Agarwala, Sandeep Bhatnagar, Veereshwar J Indian Assoc Pediatr Surg Original Article INTRODUCTION: A crossing lower polar vessel (CLPV) is found in 11%–20% of children of pelviureteric junction obstruction (PUJO). Preoperative imaging (Doppler or magnetic resonance angiography (MRA)) may help but does not form a part of routine diagnostic workup. An attempt has been made here to evaluate clinical and imaging features (ultrasound and renal dynamic scan [RDS]) in children of PUJO with CLPV and define variables that could provide a diagnostic clue to its presence. MATERIALS AND METHODS: Records of children having PUJO with CLPV over 10 years (2006–2015) were reviewed retrospectively. Their demographic profile, clinical presentation, imaging features, management, and outcomes were evaluated. RESULTS: Of 372 children with PUJO, 21 (5.6%) had a CLPV. Median age at presentation was 7 years (range 4 months–11 years). Presenting features included pain (66.6%), urinary tract infection (14.3%), antenatally diagnosed fetal hydronephrosis (14.3%) and lump (4.8%). All had an obstructive drainage on RDS and mean split renal function (SRF) of the affected kidney was 32.5% ± 15.65%. The majority had mild-moderate hydronephrosis with intrarenal pelvis. None of the ultrasound images suggested the presence of a CLPV. Diagnosis of a CLPV was made intraoperatively in all. Dismembered pyeloplasty anterior to the vessel was done in the majority (80.9%). Mean SRF on postoperative RDS improved to 36.6% ±17.76% with nonobstructive drainage. All were asymptomatic at a mean follow-up of 34.5 ± 17.5 months (range 2–56 months). CONCLUSIONS: Pain is the predominant presenting feature in these patients who present at an older age. Despite older age at presentation, these patients have well-preserved renal function and mild hydronephrosis. No specific RDS or ultrasound findings can predict the presence of a CLPV. As the incidence of CLPV is <10% and management is essentially same as PUJO with intrinsic obstruction, preoperative Doppler or MRA are extraneous. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6042171/ /pubmed/30050259 http://dx.doi.org/10.4103/jiaps.JIAPS_207_17 Text en Copyright: © 2018 Journal of Indian Association of Pediatric Surgeons http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Gupta, Alisha
Dhua, Anjan
Agarwala, Sandeep
Bhatnagar, Veereshwar
Pelviureteric Junction Obstruction with Crossing Lower Polar Vessel: Indicators of Preoperative Diagnosis
title Pelviureteric Junction Obstruction with Crossing Lower Polar Vessel: Indicators of Preoperative Diagnosis
title_full Pelviureteric Junction Obstruction with Crossing Lower Polar Vessel: Indicators of Preoperative Diagnosis
title_fullStr Pelviureteric Junction Obstruction with Crossing Lower Polar Vessel: Indicators of Preoperative Diagnosis
title_full_unstemmed Pelviureteric Junction Obstruction with Crossing Lower Polar Vessel: Indicators of Preoperative Diagnosis
title_short Pelviureteric Junction Obstruction with Crossing Lower Polar Vessel: Indicators of Preoperative Diagnosis
title_sort pelviureteric junction obstruction with crossing lower polar vessel: indicators of preoperative diagnosis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042171/
https://www.ncbi.nlm.nih.gov/pubmed/30050259
http://dx.doi.org/10.4103/jiaps.JIAPS_207_17
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