Congenital Pelvi-ureteric Junction Obstruction Associated with Crossing Lower Pole Vessels

Background: Congenital pelvi-ureteric junction obstruction [PUJO] occurs when there is impairment of flow of urine from the renal pelvis to the proximal ureter due to inherited abnormalities of pelvi-ureteric junction [PUJ]. The presentation is usually at the 4th or 5th decade of life. It may rarely be associated with crossing lower pole vessel [CLPV]. Treatment is by Anderson- Hynes [dismembered] pyeloplasty which remove the abnormal PUJ and transposes the PUJ anterior to the offending vessels. I report a case of 45-year-old man with congenital PUJO associated with crossing lower pole vessel vessels who had dismembered Anderson -Hynes pyeloplasty.

Case report: This is a 45-year-old man who presented with 4 years history of recurrent colicky left flank pain which was relieved by passing large volume of urine. The general examination was non remarkable. The left kidney was ballotable. The abdominopelvic computerized urogram revealed severe left hydronephrosis and hyperdense structure in the region of the left kidney. He had exploration via left Gibson incision with finding of multiple crossing lower pole vessels and aperistaltic segment at PUJ. He had excision of the abnormal PUJ, transposition of the crossing vessels posteriorly and dismembered Anderson-Hynes pyeloplasty. He had uneventful recovery and was discharged home 5 days postoperatively.

Conclusion: Congenital PUJO associated with lower pole vessel is rare and may present in the 5th decade of life. Anderson- Hynes dismembered pyeloplasty is the procedure of choice and associated with good outcome.

Keywords: Congenital; Pelvi-ureteric junction obstruction; Crossing vessels; Dismembered pyeloplasty; Anderson hynes; Hydronephrosis

Abbreviations: PUJO: Pelvi-ureteric junction obstruction; PUJ: Pelvi-ureteric junction; CLPV: Crossing lower pole vessel