title: Nephron sparing management of Fraley's syndrome with a pyelopyelostomy.
abstract: OBJECTIVE
  We describe a new technique for nephron sparing management of functionally significant vascular compression of the upper pole infundibulocaliceal system (Fraley's syndrome).
  
  
  METHODS
  Two patients evaluated for debilitating, narcotic dependent flank pain had significant upper pole infundibulocaliceal obstruction resulting from aberrant major arterial branches entering the hilum dorsally. Reconstructive surgery consisted of dismembered pyelopyelostomy with transposition of the crossing vessels in both patients.
  
  
  RESULTS
  Pain relief was immediate and complete in both patients. Followup radiographic evaluation at 1 and 12 months, respectively, has also documented resolution of the obstruction.
  
  
  CONCLUSIONS
  Vascular compression causing obstruction of the superior infundibulum can cause debilitating pain. Pathophysiologically operative intervention can be nephron sparing and gratifying for the surgeon and the patient.
authors.affiliation: Department of Urology, Cleveland Clinic Foundation, Ohio, USA.
authors.forename: S
authors.initials: S
authors.lastname: Fazeli-Matin
authors.forename: S B
authors.initials: SB
authors.lastname: Streem
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007670:Kidney Calices / Q000098:blood supply* / Q000601:surgery*; D007674:Kidney Diseases / Q000601:surgery; D008875:Middle Aged; D013577:Syndrome