Patil Neehar, Shubha Attibele Mahadevaiah, Das Kanishka
Department of Paediatric Surgery, St. John's Medical College, Bengaluru, Karnataka, India.
Department of Paediatric Surgery, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India.
J Indian Assoc Pediatr Surg. 2022 May-Jun;27(3):297-303. doi: 10.4103/jiaps.JIAPS_28_21. Epub 2022 May 12.
Pelviureteric junction obstruction (PUJO) due to aberrant lower polar artery is conventionally managed with pyeloplasty. We present our experience of managing PUJO due to "vascular" anomalies-aberrant lower polar artery and vascular adhesions with simpler surgical options.
This is a protocol based, retrospective study of PUJO. Preoperative investigations included ultrasonography (USG) and diuretic renogram. An intraoperative methylene blue test (MBT) assessed transit across the Pelviureteric junction (PUJ) after release of vascular compression. Surgical management included adhesiolysis for vascular adhesions and pyelopyelostomy anterior to the aberrant polar artery. Postoperative studies were repeated after 3 and 6 months.
Fourteen of 144 PUJO (9.7%) were "vascular" obstructions. Those with vascular adhesions (six) were largely infants with antenatal hydronephrosis. Children with aberrant lower polar artery (eight) were older, had fleeting symptoms, minimally increased pelvic diameter and subtle impairment on diuretic renogram. Majority were term males with urinary tract infection. The MBT showed normal transit across the PUJ in all. Postoperatively, there was progressive improvement on USG and diuretic renogram after 3 and 6 months. None had any complication or redosurgeries. At a mean follow-up of 41.2 months, all are asymptomatic.
PUJO due to extrinsic vascular anomalies is rare. Intraoperative evaluation with the MBT ruled out associated intrinsic pathology. We describe two simple surgical alternatives preserving the normal PUJ - adhesiolysis for vascular adhesions and pyelopyelostomy for aberrant lower polar artery. The preliminary outcomes are comparable to conventional pyeloplasty.
因异常下极动脉导致的肾盂输尿管连接部梗阻（PUJO）传统上采用肾盂成形术治疗。我们介绍了我们使用更简单的手术方法治疗因“血管”异常（异常下极动脉和血管粘连）导致的PUJO的经验。
这是一项基于方案的PUJO回顾性研究。术前检查包括超声检查（USG）和利尿肾图。术中亚甲蓝试验（MBT）在解除血管压迫后评估肾盂输尿管连接部（PUJ）的通过情况。手术治疗包括对血管粘连进行粘连松解以及在异常极动脉前方进行肾盂肾盂吻合术。术后3个月和6个月重复进行检查。
144例PUJO中有14例（9.7%）为“血管性”梗阻。有血管粘连的患者（6例）大多是产前肾积水的婴儿。有异常下极动脉的儿童（8例）年龄较大，症状短暂，肾盂直径轻度增加，利尿肾图有轻微损害。大多数是足月男性，伴有尿路感染。MBT显示所有患者的PUJ通过情况正常。术后，3个月和6个月后USG和利尿肾图有逐步改善。无人出现任何并发症或再次手术。平均随访41.2个月时，所有患者均无症状。
因外在血管异常导致的PUJO很少见。术中MBT评估排除了相关的内在病理情况。我们描述了两种保留正常PUJ的简单手术替代方法——对血管粘连进行粘连松解以及对异常下极动脉进行肾盂肾盂吻合术。初步结果与传统肾盂成形术相当。
