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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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 ORIGINAL ARTICLE
Year : 2018  |  Volume : 23  |  Issue : 3  |  Page : 123-126

Pelviureteric junction obstruction with crossing lower polar vessel: Indicators of preoperative diagnosis


Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Prof. Veereshwar Bhatnagar
Department of Pediatric Surgery, 4th Floor, Academic Section, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_207_17

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Introduction: A crossing lower polar vessel (CLPV) is found in 11%–20% of children of pelviureteric junction obstruction (PUJO). Preoperative imaging (Doppler or magnetic resonance angiography (MRA)) may help but does not form a part of routine diagnostic workup. An attempt has been made here to evaluate clinical and imaging features (ultrasound and renal dynamic scan [RDS]) in children of PUJO with CLPV and define variables that could provide a diagnostic clue to its presence. Materials and Methods: Records of children having PUJO with CLPV over 10 years (2006–2015) were reviewed retrospectively. Their demographic profile, clinical presentation, imaging features, management, and outcomes were evaluated. Results: Of 372 children with PUJO, 21 (5.6%) had a CLPV. Median age at presentation was 7 years (range 4 months–11 years). Presenting features included pain (66.6%), urinary tract infection (14.3%), antenatally diagnosed fetal hydronephrosis (14.3%) and lump (4.8%). All had an obstructive drainage on RDS and mean split renal function (SRF) of the affected kidney was 32.5% ± 15.65%. The majority had mild-moderate hydronephrosis with intrarenal pelvis. None of the ultrasound images suggested the presence of a CLPV. Diagnosis of a CLPV was made intraoperatively in all. Dismembered pyeloplasty anterior to the vessel was done in the majority (80.9%). Mean SRF on postoperative RDS improved to 36.6% ±17.76% with nonobstructive drainage. All were asymptomatic at a mean follow-up of 34.5 ± 17.5 months (range 2–56 months). Conclusions: Pain is the predominant presenting feature in these patients who present at an older age. Despite older age at presentation, these patients have well-preserved renal function and mild hydronephrosis. No specific RDS or ultrasound findings can predict the presence of a CLPV. As the incidence of CLPV is <10% and management is essentially same as PUJO with intrinsic obstruction, preoperative Doppler or MRA are extraneous.






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