PREVENTION AND MANAGEMENT OF HEMORRHAGE ASSOCIATED WITH CAUTERY WIRE BALLOON INCISION OF URETEROPELVIC JUNCTION OBSTRUCTION

The functional significance of crossing lower pole vessels in patients with ureteropelvic junction obstruction is controversial. However, th ere is clear evidence that the incidence of such vessels in patients w ith ureteropelvic junction obstruction is significantly higher than in the general population. We report on a patient with secondary uretero pelvic junction obstruction treated with retrograde cautery wire ballo on incision in whom significant hemorrhage developed as a result of di sruption of a lower pole accessory artery crossing the ureteropelvic j unction. Angiographic intervention with selective arterial embolizatio n resulted in immediate, complete resolution with salvage of the kidne y. Because the incidence of crossing vessels is relatively high in thi s patient population, steps should be taken to identify and possibly e xclude affected patients before the use of blind incisional procedures .