Multidetector computed tomography arteriography in the preoperative assessment of patients with ureteropelvic junction obstruction.
BACKGROUND
Nowadays, endoscopic management of ureteropelvic junction (UPJ) obstruction is the treatment of choice. However, in the presence of crossing vessels, the success rate of endoscopic management decreases and the risk of hemorrhagic and vascular complications rises. The purpose of this study is to evaluate patients with UPJ obstruction using contrast enhanced multidetector computed tomography (CT) angiography to aid in surgical planning and management.


METHODS
Between 2001 and 2005, 27 patients (mean age: 43 years; age range: 17-75 years) with UPJ obstruction were studied with multidetector CT angiography. Identification and characterization of crossing vessels was performed with multidirectional images and three-directional reconstructions.


RESULTS
12 patients (44%) were found to have 16 crossing vessels (vessels in contact with the UPJ or within a vicinity of less than 2 mm). Nine of these vessels were arteries and seven were veins. Nine vessels crossed anteriorly, two posteriorly, and one anteromedially. Endopyelotomy was contraindicated in these 12 patients due to the presence of crossing vessels. Eleven out of the 12 patients underwent a pyeloplasty by open surgery or laparoscopy, where the presence of crossing vessels was confirmed. One of the 12 patients did not undergo surgery.


CONCLUSIONS
Multidetector CT angiography permits an adequate preoperative assessment of patients with UPJ obstruction as it is able to identify the presence and location of crossing vessels. Furthermore, it allows to study in detail the anatomy of the renal area and its vascular variants.
Braun
Petra
P
Department of Radiology, Hospital de la Plana, Ctra. de Vila-real a Borriana KM. 0.5, 12540 Vila-real, Spain. PetraBraun@gmx.de
Guilabert
Jose Pamies
JP
Kazmi
Faaiza
F
D000293:Adolescent; D000368:Aged; D000792:Angiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery