Skip to main content

Differences between intrinsic and extrinsic ureteropelvic junction obstruction related to crossing vessels: histology and functional analyses

World Journal of Urology volume 34, pages 577–583 (2016)Cite this article

Abstract

Purpose

In children, ureteropelvic junction obstruction (UPJO) is mostly caused by intrinsic factors (IUPJO); extrinsic UPJO are rare and often due to crossing vessels (CVs).

Methods

We retrospectively reviewed all data of children with UPJO that underwent surgery in our institution from 2004 to 2011. Analyses included age at surgery, gender, preoperative and postoperative results of ultrasound and renal scans [differential renal function (DRF); signs of obstruction], and pathology reports. Available histological specimens of cases with CV were compared to a random selection of intrinsic cases in a blinded fashion. After additional Masson’s trichrome staining, the specimens were scored for fibrosis, muscular hypertrophy, and chronic inflammation.

Results

Out of 139 patients with UPJO, 39 cases were associated with CV. Median age at surgery was 68 months (range 2–194) in the CV group and 11.5 months (range 0–188) in IUPJO group. Laparoscopic dismembered pyeloplasty (LDMP) was carried out in 134 and open DMP in five patients. Preoperative ultrasound identified 28/39 cases with CV. DRF below 40 % was more frequently seen in CV patients (p = 0.020). Histological analyses revealed no differences between the CV and IUPJO specimens in total. CV patients with higher grades of muscular hypertrophy had lower preoperative DRF, compared to those with higher preoperative DRF (p = 0.026). Functional recovery after (L)DMP was excellent in both groups.

Conclusion

We could not find any significant histological differences between CV and IUPJO in children. To obtain excellent functional recovery, surgical procedures with a definite correction of the UPJ should be preferred in paediatric patients with CV.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Notley RG (1968) Electron microscopy of the upper ureter and the pelvi-ureteric junction. Br J Urol 40(1):37–52

    CAS  Article  PubMed  Google Scholar 

  2. Kaneto H, Orikasa S, Chiba T, Takahashi T (1991) Three-D muscular arrangement at the ureteropelvic junction and its changes in congenital hydronephrosis: a stereo-morphometric study. J Urol 146(3):909–914

    CAS  PubMed  Google Scholar 

  3. Kim WJ, Yun SJ, Lee TS, Kim CW, Lee HM, Choi H (2000) Collagen-to-smooth muscle ratio helps prediction of prognosis after pyeloplasty. J Urol 163(4):1271–1275

    CAS  Article  PubMed  Google Scholar 

  4. Hosgor M, Karaca I, Ulukus C, Ozer E, Ozkara E, Sam B, Ucan B, Kurtulus S, Karkiner A, Temir G (2005) Structural changes of smooth muscle in congenital ureteropelvic junction obstruction. J Pediatr Surg 40(10):1632–1636. doi:10.1016/j.jpedsurg.2005.06.025

    Article  PubMed  Google Scholar 

  5. Kiratli PO, Orhan D, Gedik GK, Tekgul S (2008) Relation between radionuclide imaging and pathologic findings of ureteropelvic junction obstruction in neonatal hydronephrosis. Scand J Urol Nephrol 42(3):249–256. doi:10.1080/00365590701874967

    Article  PubMed  Google Scholar 

  6. Kaya C, Bogaert G, de Ridder D, Schwentner C, Fritsch H, Oswald J, Radmayr C (2010) Extracellular matrix degradation and reduced neural density in children with intrinsic ureteropelvic junction obstruction. Urology 76(1):185–189. doi:10.1016/j.urology.2009.09.097

    Article  PubMed  Google Scholar 

  7. Zeltser IS, Liu JB, Bagley DH (2004) The incidence of crossing vessels in patients with normal ureteropelvic junction examined with endoluminal ultrasound. J Urol 172(6 Pt 1):2304–2307

    Article  PubMed  Google Scholar 

  8. Boylu U, Oommen M, Lee BR, Thomas R (2009) Ureteropelvic junction obstruction secondary to crossing vessels-to transpose or not? The robotic experience. J Urol 181(4):1751–1755. doi:10.1016/j.juro.2008.11.114

    Article  PubMed  Google Scholar 

  9. Chang SJ, Hsu CK, Hsieh CH, Yang SS (2015) Comparing the efficacy and safety between robotic-assisted versus open pyeloplasty in children: a systemic review and meta-analysis. World J Urol. doi:10.1007/s00345-015-1526-3

    Google Scholar 

  10. Lima M, Ruggeri G, Messina P, Tursini S, Destro F, Mogiatti M (2015) One-trocar-assisted pyeloplasty in children: an 8-year single institution experience. Eur J Pediatric Surg 25(3):e1. doi:10.1055/s-0034-1394280

    Google Scholar 

  11. Rassweiler JJ, Subotic S, Feist-Schwenk M, Sugiono M, Schulze M, Teber D, Frede T (2007) Minimally invasive treatment of ureteropelvic junction obstruction: long-term experience with an algorithm for laser endopyelotomy and laparoscopic retroperitoneal pyeloplasty. J Urol 177(3):1000–1005. doi:10.1016/j.juro.2006.10.049

    Article  PubMed  Google Scholar 

  12. Pesce C, Campobasso P, Costa L, Battaglino F, Musi L (1999) Ureterovascular hydronephrosis in children: Is pyeloplasty always necessary? Eur Urol 36(1):71–74. doi:10.1159/000019930

    CAS  Article  PubMed  Google Scholar 

  13. Sakoda A, Cherian A, Mushtaq I (2011) Laparoscopic transposition of lower pole crossing vessels (‘vascular hitch’) in pure extrinsic pelvi-ureteric junction (PUJ) obstruction in children. BJU Int 108(8):1364–1368. doi:10.1111/j.1464-410X.2011.10657.x

    Article  PubMed  Google Scholar 

  14. Nerli RB, Jayanthi VR, Reddy M, Koura A (2009) Pelvi-ureteric junction obstruction with crossing renal vessels: a case report of failed laparoscopic vascular hitch. J Pediatr Urol 5(2):147–150. doi:10.1016/j.jpurol.2008.09.009

    CAS  Article  PubMed  Google Scholar 

  15. Janetschek G, Peschel R, Altarac S, Bartsch G (1996) Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction. Urology 47(3):311–316. doi:10.1016/s0090-4295(99)80444-0

    CAS  Article  PubMed  Google Scholar 

  16. Fuchs J, Luithle T, Warmann SW, Haber P, Blumenstock G, Szavay P (2009) Laparoscopic surgery on upper urinary tract in children younger than 1 year: technical aspects and functional outcome. J Urol 182(4):1561–1568. doi:10.1016/j.juro.2009.06.063

    CAS  Article  PubMed  Google Scholar 

  17. Gupta M, Smith AD (1998) Crossing vessels. Endourologic implications. Urol Clin N Am 25(2):289–293

    CAS  Article  Google Scholar 

  18. Dewan PA, Ng KP, Ashwood PJ (1998) The relationship of age to pathology in pelviureteric junction obstruction. J Paediatr Child Health 34(4):384–386

    CAS  Article  PubMed  Google Scholar 

  19. Veyrac C, Baud C, Lopez C, Couture A, Saguintaah M, Averous M (2003) The value of colour Doppler ultrasonography for identification of crossing vessels in children with pelvi-ureteric junction obstruction. Pediatr Radiol 33(11):745–751. doi:10.1007/s00247-003-1012-8

    Article  PubMed  Google Scholar 

  20. Wang Y, Puri P, Hassan J, Miyakita H, Reen DJ (1995) Abnormal innervation and altered nerve growth factor messenger ribonucleic acid expression in ureteropelvic junction obstruction. J Urol 154(2 Pt 2):679–683

    CAS  Article  PubMed  Google Scholar 

  21. Harish J, Joshi K, Rao KL, Narasimhan KL, Samujh R, Choudhary SK, Mahajan JK (2003) Pelviureteric junction obstruction: how much is the extent of the upper ureter with defective innervation needing resection? J Pediatr Surg 38(8):1194–1198

    CAS  Article  PubMed  Google Scholar 

  22. Foote JW, Blennerhassett JB, Wiglesworth FW, Mackinnon KJ (1970) Observations on the ureteropelvic junction. J Urol 104(2):252–257

    CAS  PubMed  Google Scholar 

  23. Murakumo M, Nonomura K, Yamashita T, Ushiki T, Abe K, Koyanagi T (1997) Structural changes of collagen components and diminution of nerves in congenital ureteropelvic junction obstruction. J Urol 157(5):1963–1968

    CAS  Article  PubMed  Google Scholar 

  24. Richstone L, Seideman CA, Reggio E, Bluebond-Langner R, Pinto PA, Trock B, Kavoussi LR (2009) Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology 73(4):716–719. doi:10.1016/j.urology.2008.10.069 (discussion 719)

    Article  PubMed  Google Scholar 

  25. Yiee JH, Johnson-Welch S, Baker LA, Wilcox DT (2010) Histologic differences between extrinsic and intrinsic ureteropelvic junction obstruction. Urology 76(1):181–184. doi:10.1016/j.urology.2010.02.007

    Article  PubMed  Google Scholar 

  26. Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q (2011) Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol 25(5):727–736 (Provisional abstract)

    Article  PubMed  Google Scholar 

  27. El-Ghoneimi A, Farhat W, Bolduc S, Bagli D, McLorie G, Aigrain Y, Khoury A (2003) Laparoscopic dismembered pyeloplasty by a retroperitoneal approach in children. BJU Int 92(1):104–108 (discussion 108)

    CAS  Article  PubMed  Google Scholar 

  28. Godbole P, Mushtaq I, Wilcox DT, Duffy PG (2006) Laparoscopic transposition of lower pole vessels—the ‘vascular hitch’: an alternative to dismembered pyeloplasty for pelvi-ureteric junction obstruction in children. J Pediatr Urol 2(4):285–289. doi:10.1016/j.jpurol.2005.11.017

    CAS  Article  PubMed  Google Scholar 

  29. Gundeti MS, Reynolds WS, Duffy PG, Mushtaq I (2008) Further experience with the vascular hitch (laparoscopic transposition of lower pole crossing vessels): an alternate treatment for pediatric ureterovascular ureteropelvic junction obstruction. J Urol 180(4 Suppl):1832–1836. doi:10.1016/j.juro.2008.05.055 (discussion 1836)

    Article  PubMed  Google Scholar 

  30. Nouralizadeh A, Simforoosh N, Basiri A, Tabibi A, Soltani MH, Kilani H (2010) Laparoscopic management of ureteropelvic junction obstruction by division of the aberrant vein and cephalad relocation of the crossing artery: a long-term follow-up of 42 cases. J Endourol 24(6):987–991. doi:10.1089/end.2009.0524

    Article  PubMed  Google Scholar 

  31. Schneider A, Ferreira CG, Delay C, Lacreuse I, Moog R, Becmeur F (2013) Lower pole vessels in children with pelviureteric junction obstruction: laparoscopic vascular hitch or dismembered pyeloplasty? J Pediatr Urol 9(4):419–423. doi:10.1016/j.jpurol.2012.07.005

    CAS  Article  PubMed  Google Scholar 

  32. Singh RR, Govindarajan KK, Chandran H (2010) Laparoscopic vascular relocation: alternative treatment for renovascular hydronephrosis in children. Pediatr Surg Int 26(7):717–720. doi:10.1007/s00383-010-2623-4

    CAS  Article  PubMed  Google Scholar 

  33. Subotic S, Weiss H, Wyler S, Rentsch CA, Rassweiler J, Bachmann A, Teber D (2013) Dismembered and non-dismembered retroperitoneoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction in children. World J Urol 31(3):689–695. doi:10.1007/s00345-012-0887-0

    Article  PubMed  Google Scholar 

Download references

Author contribution

V. Ellerkamp, J. Fuchs: Protocol/project development; V. Ellerkamp, R.R. Kurth S. Zundel: Data collection or management; V. Ellerkamp, R. R. Kurth, E. Schmid: Data analysis; V. Ellerkamp, S. W. Warmann, E. Schmid: Manuscript writing/editing.

Author information

Affiliations

  1. Department for Pediatric Surgery and Pediatric Urology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, Tuebingen, 72076, Germany

    V. Ellerkamp, E. Schmid, S. Zundel, S. W. Warmann & J. Fuchs

  2. Institutes for Pathology and Neuropathology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, Tuebingen, 72076, Germany

    R. R. Kurth

Authors
  1. V. Ellerkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. R. Kurth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Zundel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. W. Warmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Ellerkamp.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The project was approved by the Independent Ethics Committee (IRB-Votum, IEC, Project No. 566/2014R).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ellerkamp, V., Kurth, R.R., Schmid, E. et al. Differences between intrinsic and extrinsic ureteropelvic junction obstruction related to crossing vessels: histology and functional analyses. World J Urol 34, 577–583 (2016). https://doi.org/10.1007/s00345-015-1645-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-015-1645-x

Keywords

  • Crossing vessels
  • Hydronephrosis
  • Ureteral obstruction
  • Child
  • Hydronephrosis