Histopathology in Ureteropelvic Junction Obstruction with and Without Crossing Vessels

• Published in: Urology (Ridgewood, N.J.) N.J.), 2017-09, Vol.107, p.209-213
• Main Authors: Cancian, Madeline, MD, Pareek, Gyan, MD, Caldamone, Anthony, MD, Aguiar, Liza, MD, Wang, Hai, MD, Amin, Ali, MD
• Format: Article
• Language: English
• Subjects: Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2017.05.013

Abstract Objective To determine if the histopathology of the ureteropelvic junction differs between those with and without crossing vessels who present with a ureteropelvic junction obstruction. Materials and Methods Our database was queried for patients undergoing pyeloplasty (CPT 50400, 50405, 50544) between 6/1/2002 to 3/10/3016. We excluded patients with other renal anatomic abnormalities and patients undergoing surgery for upper tract tumor. One genitourinary pathologist reviewed all slides for muscle hypertrophy, fibrosis, edema and inflammation. Statistics were modeled in SAS 9.4 using logistic regression with maximum likelihood. Results 178 patients met inclusion criteria, pathology slides were available for 136 patients. 33 patients had crossing vessels in association with an ureteropelvic junction obstruction. Degree of muscle hypertrophy (p=0.89) and fibrosis (p=0.17) were not predictive of etiology. Odds of crossing vessel increased by 4.3 times (95% CI [1.8, 9.9]) when edema was present (p=.009) and by 4.4 (95% CI [1.4, 13.7]) times when inflammation was present (p=.0103). Conclusions In the largest pathology series to date, histopathology showed increased inflammation in the presence of a crossing vessel however similar composition of muscle and fibrosis. These data suggest that UPJO with an associated lower pole vessel may represent a chronic process which would explain why patients with a crossing vessel present later in life.