Full text PDF (4.6MB) - Jurnalul de Chirurgie

Articole originale Jurnalul de Chirurgie, Iasi, 2007, Vol. 3, Nr. 2 [ISSN 1584 – 9341]SINDROMUL DE JONCŢIUNE PIELO-URETERALĂ CONGENITALPRIN VAS POLAR INFERIOR - ROLUL EXPLORĂRILORIMAGISTICE ÎN STRATEGIA TERAPEUTICĂC. Novac, C. Ciută, B. Novac, L. Todosi, I. Tomac, Veronica TănasăClinica de Urologie şi Transplant RenalSpitalul Clinic „C.I. Parhon” IaşiUniversitatea de Medicină şi Farmacie „Gr.T. Popa“ IaşiCROSSING VESSELS IN THE URETEROPELVIC JUNCTION OBSTRUCTION: ROLE OF THEIMAGING METHODS IN SURGICAL TREATMENT PLANNING (Abstract): BACKGROUND: Theknowledge of asssociation of the crossing vessels in the ureteropelvic junction obstruction is important inplanning the therapeutic strategy (endoscopic procedure, laparoscopic or open pyeloplasty). Next to the wellknownimaging methods (ultrasonography-US, intravenous urography-IVU and retrograde pyelography-RP) isadded the Doppler colour ultrasonography (US) which in the hands of a well-trained uroradiologist is reliableenough in the preoperative diagnosis of the vessels crossing at the ureteropelvic junction. But there is acontroversy regarding the functional significance of this vessels in the ureteropelvic obstruction, because theinformation brought by Doppler colour US relyes on topographical data. Crossing vessels are important for tworeasons: they are a potential source of hemorrhage following endoscopic incision and they may play an etiologicrole in ureteropelvic junction obstruction and therefore may be a reason for failure of endoscopic techniques.OBJECTIVE: This article reviews the reliability of the imaging methods, especially colour Doppler US, in thedetection of crossing vessels in patients with surgically proven ureteropielic junction obstruction. METHODS:The files of all 117 patients who were diagnosed with ureteropelvic junction obstruction in our clinic between2002 and 2005 were reviewed. There were selected and analysed the cases of 21 patients surgically treated andintra-operative diagnosed with crossing vessels. The indication for surgery was according to the usual criteria.RESULTS: Usual imaging methods (US, IVU) were used in all cases, and RP only in 9 selected cases. Theresults cleared up the three goals of imaging for ureteropelvic junction obstruction: to determine the presenceand degree of renal obstruction, to assess renal function, and to determine the cause of the problem. For this finalobjective, Doppler colour US proved to have a sensibility of 79,6% in detecting the crossing vessels.CONCLUSION: Colour Doppler US is reliable in the detection of crossing vessels at the ureteropelvic junctionguiding the strategy to open dismembered pyeloplasty.KEY WORDS: URETEROPELVIC JUNCTION, CROSSING VESSELS, COLOUR DOPPLER,PYELOPLASTYCorespondenţă: Dr. Ciută Cătălin, Clinica de Urologie şi Transplant Renal, Spitalul Clinic „C.I. Parhon” Iaşi,Bd. Carol I, Nr. 50, 700503, Iaşi; e-mail: cataciuta@yahoo.com *INTRODUCEREUna din etiologiile sindromului obstructiv congenital al joncţiunii pielo-ureterale estevasul polar inferior („crossing vessels”), reprezentat de acele artere sau vene renale care irigăo parte a polulului inferior renal. Uneori traiectul acestor vase încrucişează joncţiunea pieloureteralăsau ureterul subjoncţional. Trebuie însă diferenţiat rolul acestora în etiopatogeniabolii ştiut fiind faptul că există vase polare inferioare „inocente”, fără nici o implicare cauzalăîn apariţia bolii [1,2]. Depistarea preoperatorie a prezenţei unui vas polar inferior responsabilprobabil de apariţia sindromului de joncţiune pielo-ureterală, atât de plastic descris determinologia anglo-saxonă „crossing vessels”, este foarte importantă pentru alegerea metodeiterapeutice, cunoscut fiind faptul că prezenţa sa reprezintă o contraindicaţie pentruintervenţiile endoscopice (endopielotomie antero- sau retrogradă, endopielotomie Acucise).Opţiunea terapeutică în aceste cazuri este pieloplastia deschisă sau laparoscopică însoţită de* received date: 4.12.2007accepted date: 10.02.2007148