The study analyzed surgical approaches for treating hydronephrosis in 65 patients (aged 1.5 to 47 years) caused by the presence of accessory (aberrant) renal vessels in the ureteropelvic segment (UPS). These vessels are a common cause of hydronephrosis (18–52%), leading to urodynamic disorders due to dyskinesia and, eventually, scarring and narrowing of the UPS.
The authors advocate that open surgery remains the method of choice, especially in young patients, as it allows for clear identification of changes and reliable performance of reconstructive surgery without compromising renal hemodynamics. In contrast, endoscopic methods cannot eliminate the main cause of obstruction. The research confirms that the most reliable method for UPS reconstruction when hydronephrosis is caused by an accessory vessel is antevasal pyelo-pyelic anastomosis. This technique prevents stenosis in the anastomosis zone in both the early and late postoperative periods, unlike ureteropyelostomy, which carries a risk of restenosis and reoperation.