Prevention and management of hemorrhage associated with cautery wire balloon incision of ureteropelvic junction obstruction.

The functional significance of crossing lower pole vessels in patients with ureteropelvic junction obstruction is controversial. However, there is clear evidence that the incidence of such vessels in patients with ureteropelvic junction obstruction is significantly higher than in the general population. We report on a patient with secondary ureteropelvic junction obstruction treated with retrograde cautery wire balloon incision in whom significant hemorrhage developed as a result of disruption of a lower pole accessory artery crossing the ureteropelvic junction. Angiographic intervention with selective arterial embolization resulted in immediate, complete resolution with salvage of the kidney. Because the incidence of crossing vessels is relatively high in this patient population, steps should be taken to identify and possibly exclude affected patients before the use of blind incisional procedures.