The Diagnosis and Surgical Treatment of Hydronephrosis Due to Aberrant Artery

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AVARIETY of lesions may produce upper urinary tract obstruction and if it occurs over a long period of time the back pressure produces a hydronephrosis. The obstruction produced by an aberrant artery is of this type and these cases constitute an interesting group whose symptomatology should be recognized in the differential diagnosis of any pain in the flank or abdomen. Its etiology lies in a congenital failure. The kidney in its embryologic ascent derives its blood supply from successively higher levels as it rises from the pelvis to its final level. As new arteries take over the nutrition of the organ, the previous ones become obliterated until, normally, a single artery remains as the blood supply to the kidney. If one of the previous arteries fails to become obliterated, this one persists and is termed an aberrant artery.

It has been estimated that aberrant vessels are present in 20 per cent of all persons, 80 per cent going to the upper pole of the kidney and 20 per cent to the lower pole. We are not concerned with the former as they are not troublesome, but 80 per cent of all aberrant arteries to the lower pole produces obstruction to the ureter with a resultant hydronephrosis (fig. 1).

Experience with these cases also has shown that these arteries always are associated with fibrous bands which cause the ureter to be closely adherent to the artery; this, I believe, is an important essential to the production of obstruction by creating a. . .



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