[Multislice CT arteriography in the pre-surgical evaluation of patients with ureteropelvic junction stenosis]. / La arteriografía por tomografía computarizada multicorte en la valoración prequirúrgica de pacientes con estenosis de la unión pieloureteral.

INTRODUCTION: The current treatment of choice for ureteropelvic stenosis is endopyelotomy, but the presence of vessels in contact with the stenotic area of the ureteropelvic junction reduces the success of these interventions and increases vascular and hemorrhagic complications. The aim of our study was to use multislice CT arteriography to evaluate patients prior to surgery for ureteropelvic junction stenosis. PATIENTS AND METHODS: 16 patients with ureteropelvic junction stenosis underwent multislice CT arteriography; multidirectional images and three-dimensional reconstructions were used to identify and characterize vessels in contact with the stenotic area of the ureteropelvic junction. RESULTS: A total of eight vessels (four arteries and four veins) in six (38%) patients were found in contact with or passing within 2 mm of the ureteropelvic junction. The vessels were located anterior to the junction in four cases; it was posterior in one case, and anteromedial in the other. Endopyelotomy was contraindicated in the six patients in whom vessels were found in contact with the ureteropelvic junction. The presence of the vessels was confirmed during surgery in five of these patients; the remaining patient did not undergo surgery). CONCLUSION: Multislice CT arteriography allows adequate presurgical evaluation of ureteropelvic junction stenosis, detecting the presence of crossing vessels and facilitating the planning of the surgical approach in these patients.

La arteriografía por tomografía computarizada multicorte en la valoración prequirúrgica de pacientes con estenosis de la unión pieloureteral / Multislice CT arteriography in the pre-surgical evaluation of patients with ureteropelvic junction stenosis

Introducción. El tratamiento de elección de la estenosis de la unión pieloureteral (UPU) es actualmente la pielotomía endoscópica, pero la presencia de vasos en contacto con el área estenótica de la UPU disminuye el éxito de estas intervenciones y aumenta las complicaciones hemorrágicas y vasculares. El objetivo de nuestro estudio es realizar una valoración prequirúrgica de los pacientes con estenosis de la UPU mediante arteriografía por tomografía computarizada (TC), utilizando la TC multicorte. Pacientes y métodos. Estudiamos 16 pacientes con estenosis de la UPU, mediante arteriografía por TC multicorte. Los estudios se valoraron con imágenes multidireccionales y reconstrucciones tridimensionales para identificar y caracterizar vasos en contacto con la UPU. Resultados. En 6 pacientes (38%) se encontraron 8 vasos en contacto con la UPU (o con una separación inferior a 2 mm). Cuatro de estos vasos eran arterias y el resto eran vasos venosos. La localización de los vasos fue en cuatro pacientes anterior a la UPU, en un caso el vaso era posterior y en el otro anteromedial. La presencia de vasos en contacto con la UPU contraindicó la pielotomía endoscópica en 6 pacientes. En 5 de estos pacientes se confirmó la presencia del vaso en la intervención quirúrgica (1 caso no fue intervenido). Conclusión. La arteriografía por TC multicorte permite una adecuada valoración prequirúrgica de las estenosis de la UPU, detectando la presencia de cruces vasculares y facilitando el planteamiento quirúrgico de estos pacientes

Introduction. The current treatment of choice for ureteropelvic stenosis is endopyelotomy, but the presence of vessels in contact with the stenotic area of the ureteropelvic junction reduces the success of these interventions and increases vascular and hemorrhagic complications. The aim of our study was to use multislice CT arteriography to evaluate patients prior to surgery for ureteropelvic junction stenosis. Patients and methods. 16 patients with ureteropelvic junction stenosis underwent multislice CT arteriography; multidirectional images and three-dimensional reconstructions were used to identify and characterize vessels in contact with the stenotic area of the ureteropelvic junction. Results. A total of eight vessels (four arteries and four veins) in six (38%) patients were found in contact with or passing within 2 mm of the ureteropelvic junction. The vessels were located anterior to the junction in four cases; it was posterior in one case, and anteromedial in the other. Endopyelotomy was contraindicated in the six patients in whom vessels were found in contact with the ureteropelvic junction. The presence of the vessels was confirmed during surgery in five of these patients; the remaining patient did not undergo surgery). Conclusion. Multislice CT arteriography allows adequate presurgical evaluation of ureteropelvic junction stenosis, detecting the presence of crossing vessels and facilitating the planning of the surgical approach in these patients