Objective: To report our 20-year experience with nephron-sparing surgery in
the treatment of Fraley's syndrome.
Materials and Methods: From September 1976 to July 1996, 6 women, 18-43 yea
rs old, underwent surgical treatment. All patients had been suffering debil
itating right flank pain for at least 6 months before the operation. Diagno
sis was in call cases made with the use of intravenous pyelography and rena
l arteriography, which showed a vascular impression on the superior infundi
bulum with secondary dilatation of the upper pole calyx. This was localized
only on the right side in 5 cases, while in 1 it was bilateral though more
severe on the right. Ipsilateral nephroptosis was observed in 2 of the pat
ients. In 2 cases in whom the superior infundibulum was sufficiently long,
an infundibulo-infundibulostomy with everted flaps was performed. In a case
in whom a short infundibulum was compressed between a venous and an arteri
al branch, Fraley's infundibulopyelostomy was carried out. In 1 patient in
whom the infundibulum was compressed by the anterior-superior segmental art
ery, a Heineke-Mikulcz-type infundibulorrhaphy was combined to vasopexy. In
the remaining 2 cases, the infundibulum was not cut: in one case, a simple
vasopexy of two vascular branches was carried out, while in the other, a m
inor arterial branch was ligated and divided. in 4 patients, nephropexy was
also performed.
Results: No significant intra- or postoperative complications were observed
. Follow-up averaged 102.5 months. Pain relief was complete in 5 cases, in
whom disappearance of the vascular impression was also radiologically demon
strated. Only 1 patient, who underwent infundibulorrhaphy and vasopexy, exp
erienced occasional flank pain and urinary infection after the operation, w
ith just a slight improvement in the excretory urogram.
Conclusions: Surgical treatment of Fraley's syndrome is indicated only in s
ymptomatic and/or complicated cases; in relation to the type of obstruction
and the anatomy of the intrarenal structures, whether excretory or vascula
r, several effective nephron-sparing techniques can be selected. Copyright
(C) 2000 S. Karger AG. Baser.