Histopathological study of crossing vessels an associated finding or cause in pelviureteric junction obstruction

Abstract

Most common cause for pelviuretericjunction (PUJ) obstruction is thought to be intrinsic defect of muscular development or the deficient nerves in the obstructed narrow segment. Other causes include obstruction from outside: crossing vessel (CV), tumor compressing PUJ etc and intramural causes. Congenital Hydronephrosis is associated with crossing vessels in 26% of cases. The purpose of this work is to evaluate histopathological changes in patients of PUJ obstruction with or without crossing vessels. This was a prospective study conducted on 128 patients who underwent pyeloplasty from January 2016 to June 2018. Of these 42 patients had associated crossing vessels. Hisopathological analysis of PUJ segment was done to look for chronic inflammation, muscular hypertrophy, fibrosis, muscle disarray and synaptophysin. Moderate to severe chronic inflammation was seen in 23.8% and 44.2% (P > 0.05) cases with CV and without CV respectively, similarly fibrosis and muscular hypertrophy was seen higher in cases without CV although these were not statistical significant. On contrary muscle disarray shows trend of higher in cases with CV but it was also not statistical significant. Synaptophysin was positive in 4.8% cases with CV and 4.7% cases without CV. Based on this study there is no significant statistical difference in the histopathological changes in patients with or without crossing vessels. So crossing vessel is not the cause but an associated finding in pelvi-ureteric junction obstruction.