Ureteropelvic junction obstruction in children by polar vessels: histological examination result

Submitted: 17 January 2023
Accepted: 15 May 2023
Published: 30 May 2023
Abstract Views: 371
PDF: 143
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


In children, ureteropelvic junction obstruction (UPJO) is mostly caused by intrinsic factors (IUPJO) such as abnormal amounts of muscle and collagen deposition; extrinsic UPJO are rare and often due to crossing vessels (CVs). What is not clear is whether there is also intrinsic UPJ pathology in patients with CV. The aim of our study was to compare the histology of the two types of obstruction and to determine whether these histologic features are distinguishable enough to enable to identify the cause of obstruction based on histologic appearance alone. We retrospectively reviewed pathology reports of 38 children with UPJO that underwent surgery in our hospital from 2008 to 2022. The intrinsic and extrinsic groups consisted of 18 and 20 patients, respectively. After ematoxylin-eosin and Gomori's trichrome staining the specimens were scored for fibrosis and muscular hypertrophy in histhopatology, and CD117 antibody were used to detect interstitial Cajal-like cells. In our study, histological analyses revealed no differences between the CV and IUPJO specimens in terms of presence and degree of fibrosis and muscular hypertrophy; likewise, for presence of interstitial Cajal-like cells.

Hsu TH, Streem SB, Nakada SY. Management of upper urinary tract obstruction. In: Wein A, Kavoussi L, Novick A, Partin A and Peters C, eds. Campbell -Walsh Urology. Philadelphia, PHL: Saunders; Vol. 2.

Mut T, Acar Ö, Oktar T, et al. Intraoperative inspection of the ureteropelvic junction during pyeloplasty is not sufficient to distinguish between extrinsic and intrinsic causes of obstruction: Correlation with histological analysis. J Pediatr Urol 2016;12,223.e1-223.e6. DOI: https://doi.org/10.1016/j.jpurol.2016.02.016

Meng MV, Stoller ML. Hellström technique revisited: laparoscopic management of ureteropelvic junction obstruction. Urology 2003;62:404-409. DOI: https://doi.org/10.1016/S0090-4295(03)00562-4

Godbole P, Mushtaq I, Wilcox D, Duffy P. Laparoscopic transposition of lower pole vessels the “vascular hitch”: an alternative to dismembered pyeloplasty for pelvic-ureteric junction obstruction in children. J Pediatr Urol 2006;2:285-289. DOI: https://doi.org/10.1016/j.jpurol.2005.11.017

Chiarenza SF, Bleve C, Fasoli L, et al. Ureteropelvic junction obstruction in children by polar vessels. Is laparoscopic vascular hitching procedure a good solution? Single center experience on 35 consecutive patients. J Pediatr Surg 2016;51:310-4. DOI: https://doi.org/10.1016/j.jpedsurg.2015.10.005

Hellström J, Giertz G, Lindblom K. Pathogenesis and treatment of hydronephrosis. In: Presentedat VIII Congreso de la Sociedad International de Urologia, Paris, France 1949.

Chapman TL. Urology in Outline. Edinburgh, London: Churchill. Livingstone, 1959; 82.

Wong MCY, Piaggio G, Damasio MB, et al. Hydronephrosis and crossing vessels in children: Optimization of diagnostic-therapeutic pathway and analysis of color Doppler ultrasound and magnetic resonance urography diagnostic accuracy. J Pediatr Urology 2018;14, 68.e1-68.e6. DOI: https://doi.org/10.1016/j.jpurol.2017.09.019

Park JM, Bloom DA. The pathophysiology of UPJ obstruction. Curr Concepts Urol Clin North Am 1998;25:161-9. DOI: https://doi.org/10.1016/S0094-0143(05)70004-5

Baker LA, Gomez RA. Embryonic development of the ureter and bladder: acquisition of smooth muscle. J Urol 1998;160:545-50. DOI: https://doi.org/10.1016/S0022-5347(01)62956-2

Herts BR. Helical CT and CT angiography for the identification of crossing vessels at the ureteropelvic junction. Urol Clin North Am 1998;25:259-69. DOI: https://doi.org/10.1016/S0094-0143(05)70013-6

Hashim H, Woodhouse CRJ. Ureteropelvic Junction Obstruction. European Urology Supplements 2012; 11:25-32. DOI: https://doi.org/10.1016/j.eursup.2012.01.004

Gundeti MS, Reynolds WS, Duffy PG, Mushtaq I. Further experience with the vascular hitch (laparoscopic transposition of lower pole crossing vessels): an alternate treatment for pediatric ureterovascular ureteropelvic junction obstruction. J Urol 2008;180:1832-6. DOI: https://doi.org/10.1016/j.juro.2008.05.055

Stern JM, Park S, Anderson LK, et al. Functional assessment of crossing vessels as etiology of ureteropelvic junction obstruction. Urology 2007;69:1022-4. DOI: https://doi.org/10.1016/j.urology.2007.02.055

Weiss DA, Kadakia S, Kurzweil R, et al. Detection of crossing vessels in pediatric ureteropelvic junction obstruction: Clinical patterns and imaging findings. J Pediatr Urol 2015;11:173.e1-5. DOI: https://doi.org/10.1016/j.jpurol.2015.04.017

Nerli RB, Jayanthi VR, Reddy M, Koura A. Pelvi-ureteric junction obstruction with crossing renal vessels: a case report of failed laparoscopic vascular hitch. J Pediatr Urol 2009;5:147-50. DOI: https://doi.org/10.1016/j.jpurol.2008.09.009

Janetschek G, Peschel R, Altarac S, Bartsch G. Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obstruction. Urology 1996;47:311-6. DOI: https://doi.org/10.1016/S0090-4295(99)80444-0

Ellerkamp V, Kurth RR, Schmid E, et al. Differences between intrinsic and extrinsic ureteropelvic junction obstruction related to crossing vessels: histology and functional analyses. World J Urol 2016;34:577-83. DOI: https://doi.org/10.1007/s00345-015-1645-x

Issi O, Deliktas H, Gedik A, et al. Does the Histopathologic Pattern of the Ureteropelvic Junction Affect the Outcome of Pyeloplasty? Urol J 2015;12:2028-31.

Cancian M, Pareek G, Caldamone A, et al. Histopathology in ureteropelvic junction obstruction with and without crossing vessels. Urology 2017;107:209-13. DOI: https://doi.org/10.1016/j.urology.2017.05.013

Santicioli P, Maggi CA. Myogenic and neurogenic factors in the control of pyeloureteral motility and ureteral peristalsis. Pharmacol Rev 1998;50:683-722.

Kodela P, Apoznanski W, Wozniak Z, Pupka A. Changes in interstitial cell of Cajal-like cells density in congenital ureteropelvic junction obstruction. Int Urol Nephrol 2012;44:7-12. DOI: https://doi.org/10.1007/s11255-011-9970-5

Kuvel M, Canguven O, Murtazaoglu M, Albayrak S. Distribution of Cajal like cells and innervation in intrinsic ureteropelvic junction obstruction. Arch Ital Urol Androl 2011;83:128-32.

Piro, E., Colombini, F., Brugnoni, M., Perilli, D., Abati, L. C., Zocca, V., Vallieri, L., & D’Alessio, A. (2023). Ureteropelvic junction obstruction in children by polar vessels: histological examination result. La Pediatria Medica E Chirurgica, 45(1). https://doi.org/10.4081/pmc.2023.308


Download data is not yet available.