PMC4719902_01
Contrast enhanced CT scan showing crossing vessel (black arrow) at upper pole infundibulum.
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Abdominal CT suggested the possibility of a crossing vessel at the right upper pole infundibulum (Fig. 1).
Retrograde pyelogram of the right kidney demonstrating caliectasis and obstruction of the upper pole infundibulum. Note the vascular impression overlying the infundibulum (black arrow).
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At the time of surgery, the stent was removed and a retrograde pyelogram demonstrated upper pole caliectasis with a filling defect corresponding to a vascular impression on the infundibulum (Fig. 2).
Intraoperative images. (a) Initial orientation of renal hilum with compression of upper pole infundibulum between anterior and posterior branches of the renal artery, (b) Suturing of the renal pelvis to complete a YV-infundibulo-pyeloplasty, (c) Final reconstruction including vasculopexy of the compressing artery using Lapra-Tys (green arrow). Ur = Ureter, RA = Renal artery, RV = Renal vein.
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A laparoscopic YV-infundibulo-pyeloplasty was initially carried out using 4-0 absorbable sutures in order to expand the diameter of the infundibulum and pull it away from the offending artery (Fig. 3).