RESUMO
The gonadal arteries (testicular or ovarian arteries) emerge normally from the lateral aspect of the abdominal aorta, a little inferior to the renal arteries. Several other sites of origin of these arteries have been recorded with the renal and accessory renal arteries being the most common. In the present case report, the testicular arteries originated from the lower polar accessory renal arteries in both sides. The testicular veins followed had the usual origin and course, while an accessory renal vein was observed only in the right side. These anomalies were combined with an abnormal left ureter exiting from the lower pole of the kidney. Only one male cadaver among 77 adult human cadavers of Caucasian origin presented this set of variations (frequency: 1.3%). Variations of renal and gonadal vessels are important, as their presence could result in vascular injury of any accessory or aberrant vessel if the surgeon does not identify them.
Las arterias gonadales (testiculares o ováricas) se originan normalmente de la parte lateral de la parte abdominal de la aorta, distal a las arterias renales. Se han registrado otros lugares de origen de estas arterias, entre ellos, los más comunes en las arterias renales y renales accesorias. En el presente caso, las arterias testiculares se originaron bilateralmente desde las arterias renales polares inferiores accesorias. Las venas testiculares siguieron el origen y curso habitual, mientras que una vena renal accesoria sólo se observó en el lado derecho. Estas anomalías se combinaron con un uréter izquierdo anormal que salía desde el polo inferior del riñón. Sólo un cadáver de sexo masculino, de origen caucásico, entre los 77 cadáveres humanos adultos, presentaba este conjunto de variaciones (frecuencia: 1,3%). Las variaciones de los vasos renales y gonadales son importantes. Su presencia, si el cirujano no los identifica, puede resultar en lesiones vasculares de algún vaso accesorio o aberrante.
Assuntos
Humanos , Adulto , Artéria Renal/anatomia & histologia , Testículo/irrigação sanguínea , Rim/irrigação sanguínea , Aorta Abdominal/anatomia & histologia , Artérias/anatomia & histologia , Ureter/irrigação sanguínea , Cadáver , Variação AnatômicaRESUMO
In 65% of the cases regarding the ventral surface of the UPJ, there was a prominent artery, vein, or both in close relation to the ventral surface of the UPJ. In only 6.8% there was an inferior polar artery crossing anteriorly to the UPJ. Therefore, many of the vessels visualized close to the UPJ and described as anomalous and etiologic in obstruction are normal segmental arteries that do not cause UPJ obstruction. In 26.7% of cases regarding the dorsal surface of the UPJ, there was a vessel crossing at or lower than 1.5 cm above the posterior surface of the UPJ. On the basis of our anatomic findings, we advise that in endopyelotomy, the incision along the stenotic UPJ be created only at its lateral aspect.
Assuntos
Pelve Renal/irrigação sanguínea , Artéria Renal/anatomia & histologia , Veias Renais/anatomia & histologia , Ureter/irrigação sanguínea , Adulto , Cadáver , Feminino , Humanos , Masculino , Obstrução Ureteral/cirurgiaRESUMO
To maximize the success rate of endopyelotomy with minimal risk of complications, some debate still persists on the technique of incising the ureteropelvic junction (UPJ), patient selection, and prognostic factors. Also, some controversy exists concerning the vascular complications associated with the procedure. In order to give anatomic background to better clarifying the issue of a crossing vessel at the UPJ, we analyzed its vascular anatomic relations in 546 kidneys divided as following: 82 three-dimensional polyester resin corrosion endocasts of the collecting system together with the intrarenal arteries, 52 endocasts of the collecting system together with the intrarenal veins, 146 endocasts of the collecting system together with the intrarenal arteries and veins simultaneously, and 266 in situ dissected kidneys. In 65% of the endocasts, we found a prominent artery, vein, or both in close relation to the ventral surface of the UPJ. Among these cases, in 45%, the relation was with the inferior segmental artery. With respect to the presence of multiple renal arteries, in only 6.8% of the cases did an inferior polar artery cross anteriorly to the UPJ. In 6.2% of the endocasts, there was a direct relation between a large vessel and the dorsal surface of the UPJ. In additional 20.5% of the cases, there was a vessel crossing lower than 1.5 cm above the posterior surface of the UPJ. Considering these anatomic findings, it is conceivable that many of the vessels seen during angiography in a close relation to the UPJ and described as anomalous and etiologic in obstruction would be normal segmental arteries that do not cause UPJ obstruction. Also, on the basis of the anatomic findings, we advise that in endopyelotomy, the incision along the stenotic UPJ wall be created only at its lateral aspect.
Assuntos
Rim/irrigação sanguínea , Rim/cirurgia , Adulto , Cadáver , Feminino , Humanos , Pelve Renal/irrigação sanguínea , Masculino , Modelos Anatômicos , Ureter/irrigação sanguíneaRESUMO
Endoluminal sonography is a technique well suited to imaging structures beyond the lumen of the hollow viscus. The development of small-diameter (6.2F), catheter-enclosed ultrasound probes has made this technique available for use within the urinary tract. It is capable of defining adjacent vessels, calculi, and masses. Ureteropelvic junction (UPJ) obstruction has been increasingly treated by incisional techniques, either nephroscopic, ureteroscopic, or radiographically controlled, with each incision at risk for causing damage to any adjacent vessel. Endoluminal sonography of the obstructed UPJ was attempted in 46 patients and completed in 45 patients, 41 with primary and 4 with secondary obstruction. Adjacent vessels could be seen in 24 patients. Twelve were located anterior or medial to the UPJ or both. Nine patients had vessels at the UPJ located laterally or anterolaterally, posterolaterally, or medially and laterally. Sonographic localization guided the choice of incision site in all patients and changed therapy in five patients. This technique also allows recognition of high insertion of the ureter into the renal pelvis. Endoluminal sonography of the obstructed UPJ is a valuable technique to determine the location and nature of associated vessels and, therefore, to guide decisions in treatment.
Assuntos
Ultrassonografia/métodos , Obstrução Ureteral/diagnóstico por imagem , Adulto , Angiografia , Artérias/diagnóstico por imagem , Desenho de Equipamento , Fluoroscopia , Humanos , Masculino , Ultrassonografia/instrumentação , Ureter/irrigação sanguínea , UrografiaRESUMO
Foi realizado um estudo sobre o peritaltismo uretral, pressäo arterial e fluxo urinário em cäes, transportando a urina da pelve renal para a bexiga, com objetivo de verificar os efeitos da enervaçäo (periférica, central e bloqueio ganglionar), a açäo das drogas adrenérgicas e medicamentos vasoativos. Concluiu-se que a enervaçäo näo alterou o peristaltismo ureteral, já as drogas adrenérgicas promoveram importantes variaçöes, similares as provocadas por medicamentos vasoativos, sugerindo que no controle do peritaltismo ureteral as mudanças no fluxo urinário säo mais importantes que os efeitos dos medicamentos empregados