Crossing Vessels as a Cause of Pelvi-Ureteric Junction (PUJ) Obstruction

Abstract

Foetal hydronephrosis is commonly caused by congenital pelviureteric Junction (PUJ) obstruction. It is either due to nerve deficiency or due to intrinsic muscular defect at PUJ or it may be due to lower polar aberrant crossing vessel just compressing the PUJ. The purpose of this study is to see the contribution of crossing vessels in causing the PUJ obstruction. Aims and objectives: (1) to find the contribution of crossing vessels in causing PUJ obstruction on naked eye examination peroperatively, (2) To histologicaly verify the cause of PUJ obstruction in cases of crossing vessels compressing the pelvi-ureteric junction (PUJ). Patients and methods: 27 cases of Congenital PUJ obstruction were taken during four year period who for operation. All underwent Anderson Hynes Pyeloplasty and specimen of PUJ with narrow segment below it was taken and preserved in 10% formalin. The specimen was sent to histopathologist along with other specimens where PUJ obstruction was not caused by crossing vessels for nerve detection by S-100 immunohistochemistry and for histopathological examination. Results: Five out of 27 cases of PUJ obstruction were caused by crossing vessels and in these five cases, four (80%) were having normal histology showing that crossing vessels were the cause of PUJ obstruction merely compressing the PUJ mechanically.