Equivocal Ureteropelvic Junction Obstruction

A 45-year-old woman presented with intermittent unilateral flank pain especially following hydration.

 In the primary evaluation, all the laboratory tests were within the normal range and the intravenous pyelogram showed mild enlargement of left pyelocaliceal system with filling of the ureter (figure 1a). DTPA scan (figure 1b) revealed normal perfusion and excretory function of both kidneys with no evidence of obstruction (split function; L/R:49%/51%).

The patient still complaint severe intermittent flank pain and several admissions to emergency room in this period of time. According to the patient’s symptoms which were characteristics for UPJO, despite the non-conclusive imaging, we candidate the patient for diagnostic and probable therapeutic laparoscopic surgery.

After the colon medialization and first look of pyelocaliceal system, aberrant vessels were identified which were passing over the uretero-pelvic junction but did not cause obstruction. After Lasix administration and patient hydration, the renal pelvis became prominent, gradually and it was found that the aberrant vessels were the cause of UPJO (figure 1c). But after the vessels transposition, the renal pelvis expansion did not disappear and as a result, dismembered pyeloplasty was inevitable. In 6 months follow up,  the patient did not have  any symptoms and IVP was completely normal with no evidence of delayed renal function or any obstruction.