Detection of crossing vessels in pediatric XXXX : Clinical patterns and imaging findings.

@entity1 @entity8 @entity3041 @entity158 @entity4145
BACKGROUND: Pediatric @entity4145 ( @entity4145 ) is caused by congenital intrinsic narrowing and/or a lower pole-crossing renal artery. When a @entity8 ( @entity8 ) is missed at the time of pyeloplasty, a redo-pyeloplasty is often required. OBJECTIVES: The aims were to analyze clinical predictors for the presence of a @entity8 in @entity4145 and the utility of functional magnetic resonance urography (fMRU) in preoperative identification of a crossing vessel. METHODS: Using an Institutional Review Board approved registry database, we identified 166 @entity1 from July of 2007 until January of 2014 who had undergone open, laparoscopic, or robotic assisted laparoscopic pyeloplasty at our institution. We abstracted data including age at surgery, preoperative symptoms, preoperative imaging findings, and whether or not a @entity8 was identified intraoperatively. Statistical analysis was performed on SPSS using the Mann-Whitney U test. RESULTS: Of the 166 @entity1 identified, 78 were found to have a @entity8 at the time of surgery and 88 did not. The surgical approach was distributed as 104 robotic assisted laparoscopic, 51 open, and 11 pure laparoscopic. On univariate analysis, older age at presentation and @entity158 at presentation predicted the presence of a @entity8 ; antenatal @entity3041 was a negative predictor, though 20 of 68 (25.6%) @entity1 diagnosed with @entity4145 antenatally did have a @entity8 . Subgroup analysis of @entity1 undergoing preoperative MRU showed a sensitivity of 88.2% and specificity of 91.7% for the detection of CRVs. DISCUSSION: This study confirmed the importance of looking for a crossing vessel in all cases, with the knowledge that increased age and @entity158 at presentation were more likely to be associated with a crossing vessel. In addition, fMRU is a valuable source of information in the preoperative identification of the presence of a crossing vessel. The study has limitations including being retrospective in nature, and that the sensitivity of fMRU to identify CRVs was based on the read of an experienced uroradiologist who specializes in MRU, so may not correlate with the standard clinical read of an fMRU. CONCLUSION: This study confirms the need to maintain a high index of suspicion for the presence of a @entity8 when intervening in a clinically symptomatic older @entity1 , although 25% of @entity1 with antenatally detected @entity4145 did have one too. Our subset analysis demonstrated that MRU is a reliable method of detecting crossing vessels.
