VARIATIONS IN ARTERIAL BLOOD-SUPPLY AND THE RISK OF HEMORRHAGE DURINGPERCUTANEOUS TREATMENT OF LESIONS OF THE PELVIURETERAL JUNCTION OBSTRUCTION - REPORT OF A CASE OF TESTICULAR ARTERY ARISING FROM AN INFERIOR POLAR RENAL-ARTERY

Acute hemorrhage during percutaneous surgery on the pelviureteric junc tion obstruction has been estimated to be 2-3%. Following the experien ce of peroperative bleeding from a vascular variation, the authors dis cuss the arterial anomalies bf the renal pedicle which may carry the r isk of hemorrhage during percutaneous surgery in this region. Arteries in front of or behind the renal pelvis are the cause of ureteropelvic function obstruction in 15-52% of cases and because of their close re lationship with the upper urinary tract can complicate the procedure o f endopyelotomy. Endourological techniques are inadequate for avoiding the risk of vascular damage during the necessary maneuvers. Inferior polar arteries occur in 9% of the population and their different cours es are described. They are not always responsible for the vascular obs truction in the pelviureteric syndrome, and it is the exact determinat ion of this responsibility that makes imaging essential. Arteriography performed in our case allowed embolisation of the damaged inferior po lar artery and also showed the anomalous origin of the testicular arte ry from this polar artery this appears to be only the second descripti on of this anomaly. This variation is discussed in a review of the lit erature. In fact the testicular artery has a high or aberrant origin i n 20% of cases; in 5-6% of these the origin is from a main or supernum erary renal artery. Origin from an inferior polar artery is exceptiona l.