URETEROPELVIC JUNCTION STENOSIS - VASCULAR ANATOMICAL BACKGROUND FOR ENDOPYELOTOMY

To help endourologists perform endopyelotomy safely and efficiently wi th a reduced risk of vascular complications, we analyzed the vascular relationships to the ureteropelvic junction in 146, 3-dimensional endo casts of the kidney collecting system together with the intrarenal art eries and veins. There was a close relationship between a prominent ve ssel (artery and/or vein) and the anterior surface of the ureteropelvi c junction in 65.1% of the cases, including the inferior segmental art ery with a tributary of the renal vein in 45.2% and an artery or vein in 19.9%. In the remaining 34.9% of the cases the anterior surface of the ureteropelvic junction was free of vessels. There was a direct rel ationship between a prominent vessel (artery and/or vein) and the post erior surface of the ureteropelvic junction in 6.2% of the cases, incl uding an artery and vein in 2.1%, and just an artery in 1.4%. In all c ases (3.5%) of an artery crossing at the posterior surface of the uret eropelvic junction, this vessel was the posterior segmental artery (re tropelvic artery). In 2.7% of the cases the relationship of the promin ent vessel was just with a posterior tributary of the renal vein, and in 20.5% a vessel crossed lower than 1.5 cm. above the posterior surfa ce of the ureteropelvic junction. Among these latter cases the vessel was an artery (posterior segmental artery) in 6.8%. In the remaining 7 3.3% of the cases the posterior surface was free of vessels up to 1.5 cm. above the ureteropelvic junction. Due to the anatomical findings, we advise that posterior and posterolateral incisions at the ureterope lvic junction be avoided, and that deep incision alongside the uretero pelvic junction stenotic wall be done only laterally.