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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2018
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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. |
format | Online Article Text |
id | pubmed-6042171 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
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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