Crossing Vessel in Pelvi Ureteric Junction Obstruction: A Histopathological Analysis

Overview

Journal Turk J Urol

Publisher Aves

Date 2022 Aug 1

PMID 35913445

Authors

Sanjeet Kumar Singh

Anjana Singh

Krishna Kumar Yadav

Gurunam Girniwale

Nuzhat Husain

Alok Srivastava

Chandra Kant Munjewar

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of the study is to identify whether crossing vessel is a cause or an associated finding in Pelvi Ureteric Junction Obstruction.

Material And Methods: This is a prospective study of a total of 128 patients who underwent laparoscopic pyeloplasty from January 2016 to June 2020. All patients who underwent laparoscopic pyeloplasty and pelvi ureteric junction segments were sent for histopathological examination. The presence of crossing vessels is documented intraoperative and patients were divided into two groups, group 1 having pelvi ureteric junction obstruction with crossing vessel, and group 2, pelvi ureteric junction obstruction without crossing vessels. Histopathological examination findings of pelvi ureteric junction segment including inflammation, fibrosis, muscle hypertrophy, muscle disarray, and synaptophysin were recorded. Unpaired Student t-test was used for comparing differences between continuous normally distributed data from 2 samples and non-parametric tests were applied for continuous data.

Results: Of the total 128 patients, crossing vessels were identified in 42 (32.8%), and 86 (67.2%) were without crossing vessels. The demographic profile of patients between the 2 groups was comparable. On histopathological examination, moderate-to-severe chronic inflammation was seen in 23.8% and 44.2% (P > .05) in group 1 and group 2, respectively; fibrosis and muscular hypertrophy were higher in group 2 but statistically insignificant (P > .05), and muscle disarray was higher in group 1 but statistically insignificant (P > .05). Synaptophysin was positive in 4.8% and 4.7% in group 1 and group 2, respectively.

Conclusion: The differences in histopathological examination between the 2 groups were not statistically significant. However, in patients with crossing vessels, there was a higher degree of inflammation, which may lead to early pelvi ureteric junction obstruction.

Citing Articles

Can the inferior mesenteric artery cause ureteropelvic junction obstruction?.

Lamiri R, Saad J, Kechiche N, Boukhrissa N, Saad N, Mekki M Radiol Case Rep. 2024; 19(12):5575-5578.

PMID: 39296745 PMC: 11406357. DOI: 10.1016/j.radcr.2024.08.046.

References

Cancian M, Pareek G, Caldamone A, Aguiar L, Wang H, Amin A . Histopathology in Ureteropelvic Junction Obstruction With and Without Crossing Vessels. Urology. 2017; 107:209-213. DOI: 10.1016/j.urology.2017.05.013. View

Madec F, Faraj S, Villemagne T, Fourcade L, Lardy H, Leclair M . Laparoscopic transposition of lower-pole crossing vessels: Long-term follow-up of 33 patients at puberty. J Pediatr Urol. 2016; 12(4):226.e1-6. DOI: 10.1016/j.jpurol.2016.03.016. View

Murakumo M, Nonomura K, Yamashita T, Ushiki T, Abe K, Koyanagi T . Structural changes of collagen components and diminution of nerves in congenital ureteropelvic junction obstruction. J Urol. 1997; 157(5):1963-8. View

Gosling J, Dixon J . Functional obstruction of the ureter and renal pelvis. A histological and electron microscopic study. Br J Urol. 1978; 50(3):145-52. DOI: 10.1111/j.1464-410x.1978.tb02790.x. View

Grasso M, Caruso R, Phillips C . UPJ Obstruction in the Adult Population: Are Crossing Vessels Significant?. Rev Urol. 2006; 3(1):42-51. PMC: 1476031. View

Godbole P, Mushtaq I, Wilcox D, Duffy P . Laparoscopic transposition of lower pole vessels--the 'vascular hitch': an alternative to dismembered pyeloplasty for pelvi-ureteric junction obstruction in children. J Pediatr Urol. 2008; 2(4):285-9. DOI: 10.1016/j.jpurol.2005.11.017. View

Richstone L, Seideman C, Reggio E, Bluebond-Langner R, Pinto P, Trock B . Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology. 2009; 73(4):716-9. DOI: 10.1016/j.urology.2008.10.069. View

Solari V, Piotrowska A, Puri P . Altered expression of interstitial cells of Cajal in congenital ureteropelvic junction obstruction. J Urol. 2003; 170(6 Pt 1):2420-2. DOI: 10.1097/01.ju.0000097401.03293.f0. View

Sakoda A, Cherian A, Mushtaq I . Laparoscopic transposition of lower pole crossing vessels ('vascular hitch') in pure extrinsic pelvi-ureteric junction (PUJ) obstruction in children. BJU Int. 2011; 108(8):1364-8. DOI: 10.1111/j.1464-410X.2011.10657.x. View

10.

Esposito C, Bleve C, Escolino M, Caione P, Gerocarni Nappo S, Farina A . Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction. Transl Pediatr. 2016; 5(4):256-261. PMC: 5107373. DOI: 10.21037/tp.2016.09.08. View

11.

Sampaio F . Vascular anatomy at the ureteropelvic junction. Urol Clin North Am. 1998; 25(2):251-8. DOI: 10.1016/s0094-0143(05)70012-4. View

12.

Ellerkamp V, Kurth R, Schmid E, Zundel S, Warmann S, Fuchs J . Differences between intrinsic and extrinsic ureteropelvic junction obstruction related to crossing vessels: histology and functional analyses. World J Urol. 2015; 34(4):577-83. DOI: 10.1007/s00345-015-1645-x. View

13.

De Siati M, Silvestre P, Scieri F, Breda G . Congenital ureteropelvic junction obstruction: definition and therapy. Arch Ital Urol Androl. 2005; 77(1):1-4. View

14.

Van Cangh P, Wilmart J, Opsomer R, Wese F, Lorge F . Long-term results and late recurrence after endoureteropyelotomy: a critical analysis of prognostic factors. J Urol. 1994; 151(4):934-7. DOI: 10.1016/s0022-5347(17)35126-1. View

15.

Sampaio F . The dilemma of the crossing vessel at the ureteropelvic junction: precise anatomic study. J Endourol. 1996; 10(5):411-5. DOI: 10.1089/end.1996.10.411. View

16.

Seremetis G, Maizels M . TGF-beta mRNA expression in the renal pelvis after experimental and clinical ureteropelvic junction obstruction. J Urol. 1996; 156(1):261-6. View

17.

Zeltser I, Liu J, Bagley D . The incidence of crossing vessels in patients with normal ureteropelvic junction examined with endoluminal ultrasound. J Urol. 2004; 172(6 Pt 1):2304-7. DOI: 10.1097/01.ju.0000145532.48711.f6. View

18.

Tatli Dogan H, Canda A, Gok B, Oguz U, Gumustas S, Atmaca A . Is there a difference in the number of interstitial cells, neurons, presence of fibrosis and inflammation in ureteropelvic junction tissues of patients with ureteropelvic junction obstruction with and without crossing vessels?. Turk J Urol. 2018; 45(4):302-306. PMC: 6619840. DOI: 10.5152/tud.2018.08784. View

19.

Hanna M, Jeffs R, Sturgess J, BARKIN M . Ureteral structure and ultrastructure. Part II. Congenital ureteropelvic junction obstruction and primary obstructive megaureter. J Urol. 1976; 116(6):725-30. DOI: 10.1016/s0022-5347(17)58987-9. View