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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (4): 705-710. doi: 10.19723/j.issn.1671-167X.2020.04.021

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Application of preoperative three-dimensional image reconstruction in the treatment of ureteropelvic junction obstruction

Meng-meng ZHENG1,2,Guang-pu DING1,Wei-jie ZHU1,Kun-lin YANG1,Shu-bo FAN1,Bao GUAN1,Xin-fei LI1,Yu-kun CAI1,Jin-sheng ZHANG2,Xue-song LI1,△(),Li-qun ZHOU1   

  1. 1. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre,Beijing 100034, China
    2. Department of Urology, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
  • Received:2019-09-11 Online:2020-08-18 Published:2020-08-06
  • Contact: Xue-song LI E-mail:pineneedle@sina.com

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Abstract:

Objective: To investigate the value of preoperative three-dimensional image reconstruction in the treatment of ureteropelvic junction obstruction (UPJO). Methods: We reviewed data on 40 patients (22 male cases,and 18 female cases) diagnosed with UPJO in Peking University First Hospital from May 2017 to April 2019. The median age was 26.5 years (IQR 23.25-38.75) years. There were 11 patients complicated with ectopic vessels,14 patients with kidney stones,3 patients with horseshoe kidney,and 6 patients with obstruction after pyeloplasty. All the patients underwent preoperative enhanced CT scan,and the CT data were reconstructed into three-dimensional image models. The obstruction position of ureteropelvic junction and the relationship between ureteropelvic junction and blood vessels and organs were observed by three-dimensional models to assist planning surgery. Thirty-seven patients underwent laparoscopic pyeloplasty (including 3 cases combined with pyelolithotomy with flexible cystoscope,1 case combined with pyelolithotomy by sun-style cystoscope, 1 case with laparoscopic ureter resection and anastomosis,3 cases of laparoscopic pyeloplasty of horseshoe kidney), 2 patients underwent laparoscopic ventral onlay lingual mucosal graft ureteroplasty, and 1 patient underwent robot-assisted laparoscopic pyeloplasty. Results: Three-dimensional CT image clearly showed the relationship between the obstruction of ureteropelvic junction and blood vessels and organs after three-dimensional reconstruction. The type,diameter,position and direction of the ectopic vessels could be observed clearly before operation according to the three-dimensional reconstruction model,and the number,size,location and shape of renal calculi or other masses,the number of involved renal calyces and the anatomical distribution in the renal pelvis and calyces could be also evaluated preoperatively. After comprehensive analysis of the above information,individualized operation plans were performed on the patients,all the 40 cases were successfully completed with the surgery without any transfer to open surgery. The average operative time was (129.91±37.90) min (range: 75 to 273), the average blood loss was (48.1±78.0) mL (range: 10 to 400), the average hospitality was (5.04±1.99) d (range: 2 to 10), and the average postoperative drainage time was (3.8±1.4) d (range: 2 to 8). Conclusion: The preoperative three-dimensional image reconstruction has a high clinical value in the treatment of ureteropelvic junction obstruction, and it is of great help to assist surgery planning and is worthy of further clinical promotion and application.

Key words: Three-dimensional image reconstruction, Ureteropelvic junction obstruction, Pyeloplasty

CLC Number: 

  • R691.2

Table 1

clinical data analysis of 40 patients diagnosed with UPJO"

Items UPJO (n=40)
Operative time/min 129.91±37.90
Blood loss/mL 48.1±78.0
Drainage time/d 3.8±1.4
Hospitalization time/d 5.04±1.99

Figure 1

Three-dimensional image model of UPJO with ectopic vessels A, case 1, UPJO caused by renal crossing artery; B, case 3, the large gap between UPJ and two ectopic arteries; C,case 5, multiple arteries and veins clinging to the renal pelvis,located in the operation area; D,case 8, heterotopic vein in front of UPJ,which located in the surgical area."

Table 2

Plinical data analysis of patients diagnosed with UPJO with ectopic vessels"

Case Type of
ectopic vessel		 Number of
branches		 Spatial relationship
between UPJ		 Spatial distance
between UPJ		 Operation
procedures
1 Artery 1 In front of UPJ Near Retained
2 Artery 1 In front of UPJ Far Retained
3 Artery 2 Behind the UPJ Far Retained
4 Arteries and veins A: 1/V: 1 Behind the UPJ Far Retained
5 Arteries and veins A: 4/V: 3 In front of the renal pelvis Near Cut off
6 Artery 1 In front of UPJ Far Cut off
7 Arteries and veins A: 1/V: 1 In front of UPJ Near Retained
8 Vein 1 In front of UPJ Near Cut off
9 Artery 1 In front of UPJ Near Retained
10 Artery 1 In front of the renal pelvis Near Retained
11 Arteries and veins A: 3/V: 2 In front of the renal pelvis Near Retained

Figure 2

Three-dimensional model of UPJO with kidney stones A, the location and shape of urinary stone located in the lower calyces could be clearly identified when renal tissue and blood vessels were eliminated; B, the maximum length axis and the maximum diameter of the stone could be found and measured by adjusting the spatial orientation and angle in the 3D mode."

Figure 3

Three-dimensional image model of UPJO with horseshoe kidney and UPJO after pyeloplasty A, horseshoe kidney with UPJO, with many vessels around the isthmus of horseshoe kidney, which includes small arteries and a vein across the renal pelvis; B, UPJO after pyeloplasty, with rough upper ureteral segment."

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