Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

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11:55 - 11:58
S8-5 (PP)
IS INTRAOPERATIVE INSPECTION OF THE UPJ DURING PYELOPLASTY A
SUFFICIENT WAY TO DELINEATE THE UNDERLYING CAUSE OF OBSTRUCTION?
Tuna MUT1, Omer ACAR2, Tayfun OKTAR3, Isin KILIÇASLAN4 and Orhan ZIYLAN5
1) American Hospital, Department of Urology, Istanbul, TURKEY - 2) Koc University,School of Medicine, Department of
Urology, Istanbul, TURKEY - 3) Istanbul University,Istanbul Faculty of Medicine, Department of Urology, Istanbul,
TURKEY - 4) Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, TURKEY - 5) Istanbul
University, Istanbul Faculty of Medicine, Department of Urology, Istanbul, TURKEY
PURPOSE
Ureteropelvic junction obstruction (UPJO) is the result of intrinsic or extrinsic causes. Recently popularized vascular hitch
technique, which presumes no intrinsic narrowing, eliminates the compelling dismembering procedure in
laparoscopic/robotic interventions. Inspecting the peristaltism of the ureter after relieving the extrinsic obstruction due
to aberrant vessel to rule out an intrinsic component, may not be sufficient to justify that the extrinsic compression is
the sole cause of obstruction. Herein, we aimed to compare the histological changes observed in intrinsic and extrinsic
types of UPJO.
MATERIAL AND METHODS
We retrospectively reviewed the data of 56 patients who underwent dismembered pyeloplasty due to UPJO in our clinic.
Patients with an aberrant crossing vessel constituted the extrinsic group and those without such an identifiable vessel
formed the intrinsic group.
Masson's trichrome stain, CD117 and connexin 43 (Cx43) antibody were used to identify muscular hypertrophy/fibrosis,
cajal cells and gap junctions, respectively.
RESULTS
The intrinsic and extrinsic groups consisted of 38 and 18 patients, respectively. The level of smooth muscle hypertrophy,
CD117 positive cell count and Cx43 staining pattern did not differ significantly between intrinsic and extrinsic groups.
CONCLUSIONS
Immunohistochemical profile of the intrinsic and extrinsic UPJOs resemble each other. Intraoperative inspection of the
UPJ may not be enough for an accurate discrimination. A surgical procedure that can correct only an extrinsic cause will
ultimately fail in a patient whose UPJO is due to an intrinsic reason. Dismembered pyeloplasty serves well for both
possible types of UPJO.