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Crossing vessels are not important in the etiology of ureteropelvic junction obstruction

Nature Clinical Practice Urology volume 3, pages 568–569 (2006)Cite this article

The advent of laparoscopic and robotic pyeloplasty offers urologists additional tools in their armamentaria for the treatment of ureteropelvic junction obstruction (UPJO). Along with antegrade endopyelotomy, these modalities have shown outstanding results, and have proven superior to retrograde approaches. With the popularization of these techniques has come a resurgence in the debate over the role of crossing vessels in the pathogenesis of UPJO, and their influence on the outcomes of various endourologic procedures.

In considering this question, it is first important to acknowledge that the mere presence of crossing vessels is not tantamount to UPJO. In truth, we have no real understanding of the prevalence of crossing vessels, as the vast majority of individuals with this anatomic variant never come to the attention of a urologist or radiologist. Moreover, many renal units found at surgery, autopsy, or on radiological investigation to have anomalous vessels arising from the renal or great vessels are not hydronephrotic. Sampaio and Favorito showed that 71% of kidneys have a vessel (artery or vein) crossing within 1.5 cm of the ureteropelvic junction.1,2 Most of these vessels are not aberrant arteries, but arise from the aorta or main renal artery, and can supply up to half of the renal parenchyma.

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Authors and Affiliations

  1. Department of Urology at the North Shore–Long Island Jewish Health System, Long Island

    Jonathan D Kaye, Michael C Ost, Evan R Eisenberg & Arthur D Smith

  2. Department of Urology, Long Island Jewish Medical Center, New Hyde Park

    Jonathan D Kaye, Michael C Ost, Evan R Eisenberg & Arthur D Smith

  3. Bi-County Urological Associates in Seaford,

    Jonathan D Kaye, Michael C Ost, Evan R Eisenberg & Arthur D Smith

  4. Department of Urology at Long Island Jewish Medical Center, New Hyde Park, NY, USA

    Jonathan D Kaye, Michael C Ost, Evan R Eisenberg & Arthur D Smith

Authors
  1. Jonathan D Kaye
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  2. Michael C Ost
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  3. Evan R Eisenberg
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  4. Arthur D Smith
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Correspondence to Arthur D Smith.

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Kaye, J., Ost, M., Eisenberg, E. et al. Crossing vessels are not important in the etiology of ureteropelvic junction obstruction. Nat Rev Urol 3, 568–569 (2006). https://doi.org/10.1038/ncpuro0597

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