PMID- 12823391
OWN - NLM
STAT- MEDLINE
DCOM- 20030812
LR  - 20220318
IS  - 1464-4096 (Print)
IS  - 1464-4096 (Linking)
VI  - 92
IP  - 1
DP  - 2003 Jul
TI  - Pelvi-ureteric junction obstruction by crossing renal vessels: clinical and 
      imaging features.
PG  - 101-3
AB  - OBJECTIVE: To present the characteristic clinical and imaging findings of 
      pelvi-ureteric junction (PUJ) obstruction caused by crossing renal vessels (CRV), 
      as it presents particular features within the spectrum of congenital 
      hydronephrosis. PATIENTS AND METHODS: Between April 1982 and December 2000, 384 
      children underwent surgery for PUJ obstruction. In 71 (18.5%; mean age 8.5 years, 
      range 2 months to 14 years; 49 aged> 5 years), the obstruction was caused by CRV. 
      The data collected from the medical records of these patients were analysed for 
      their clinical presentation and imaging findings, i.e. ultrasonography (US), 
      intravenous urography (IVU) and diuretic renography. RESULTS: The main presenting 
      symptom was recurrent renal colic (pain, nausea, vomiting) in 59%, followed by 
      urinary infection (UTI) in 20%, gross haematuria in 11% and an incidental 
      diagnosis in 10%. By contrast, in the 313 children with intrinsic PUJ 
      obstruction, renal colic was present in only 10.5%. Moreover, from 1991 to 2000, 
      when the use of prenatal US became widespread, hydronephrosis was detected 
      prenatally in 42 of 212 children (20%) with intrinsic PUJ obstruction, but in 
      only two of 31 (6%) with obstruction by CRV. However, in 10 children with CRV 
      operated on during this period, prenatal US had shown mild hydronephrosis (< 15 
      mm), which during the follow-up decreased until the children became symptomatic 
      after 5-9 years (eight renal colic, two UTI). US during acute symptoms showed 
      significant hydronephrosis (> 25 mm), and colour Doppler US of two patients 
      directly showed the CRV. In all 71 children with CRV obstruction diuretic IVU and 
      renography during the acute symptoms had an obstructive pattern, and in 24 renal 
      colic was reproduced during the examination. The differential kidney function was 
      < 40% in 11 children who presented with UTI; two required nephrectomy and in the 
      remaining 69 an Anderson-Hynes pyeloplasty, after which none had an episode of 
      renal colic or UTI during a mean (range) follow-up of 10.2 (2-20) years. 
      CONCLUSIONS: PUJ obstruction by CRV should be suspected in older children 
      presenting with recurrent renal colic and hydronephrosis. Good kidney function is 
      expected in most of these children, despite their age, because the vascular 
      obstruction is intermittent. Mild prenatal hydronephrosis that could decrease 
      postnatally does not exclude the possibility of vascular obstruction, which may 
      later become symptomatic. Imaging (US, diuretic IVU and renography) during an 
      episode of pain is essential and colour Doppler US could help to establish the 
      diagnosis in these cases. Knowing that a child has a CRV is important for 
      choosing an open surgical approach rather than endoscopic pyelotomy, to avoid 
      potential complications
FAU - Rigas, A
AU  - Rigas A
AD  - Department of Paediatric Urology, Aghia Sophia Children's Hospital, Athens, 
      Greece. rigasth@hotmail.com
FAU - Karamanolakis, D
AU  - Karamanolakis D
FAU - Bogdanos, I
AU  - Bogdanos I
FAU - Stefanidis, A
AU  - Stefanidis A
FAU - Androulakakis, P A
AU  - Androulakakis PA
LA  - eng
PT  - Journal Article
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Colic/etiology
MH  - Female
MH  - Humans
MH  - Hydronephrosis/congenital/diagnosis/etiology
MH  - Infant
MH  - Kidney Diseases/etiology
MH  - Male
MH  - Radioisotope Renography/methods
MH  - Recurrence
MH  - Retrospective Studies
MH  - Ureter/abnormalities/*blood supply
MH  - Ureteral Obstruction/diagnosis/etiology/*surgery
MH  - Urography/methods
EDAT- 2003/06/26 05:00
MHDA- 2003/08/13 05:00
CRDT- 2003/06/26 05:00
PHST- 2003/06/26 05:00 [pubmed]
PHST- 2003/08/13 05:00 [medline]
PHST- 2003/06/26 05:00 [entrez]
AID - 4265 [pii]
AID - 10.1046/j.1464-410x.2003.04265.x [doi]
PST - ppublish
SO  - BJU Int. 2003 Jul;92(1):101-3. doi: 10.1046/j.1464-410x.2003.04265.x.