Radiological anatomical study of the origin of the uterine artery.

PURPOSE: To clarify the origin of the uterine artery and quantify its anatomical variants. MATERIALS AND METHODS: We carried out a study based on dissections, intraoperative findings and retrospective analysis of arteriograms. Thirty female cadavers were dissected and bilaterally observed, with a total of 60 origins visualised. Fifty laparotomies were carried out during the treatment for pelvic neoplasms (100 origins observed) and 34 arteriograms performed for uterine fibroid embolisation were studied (58 origins visualised). RESULTS: In total, 218 origins of the uterine artery were visualised. The uterine artery originated from a common trunk with the umbilical artery in 80.7% of cases. It arose separately from the internal iliac artery in 13.16% of cases and directly from the superior gluteal artery in 3.51% of cases. It branched from a common trunk with the internal pudendal artery in 1.75% of cases, whereas arose separately from the obturator artery in 0.88% of cases. CONCLUSION: The uterine artery arose from a common trunk with the umbilical artery in the majority of the Caucasian population. Surgeons and radiologists should be aware of this mode of branching to facilitate surgery and interventional radiology and improve the safety of these procedures.

Influence of preoperative hydronephrosis on the outcome of urothelial carcinoma of the upper urinary tract after nephroureterectomy: the results from a multi-institutional French cohort.

OBJECTIVES: Recent publications have assessed the prognostic significance of hydronephrosis in the outcome of upper tract urothelial carcinoma (UUT-UC). Our study sought to determine the prognostic impact of hydronephrosis on UUT-UC survival and its relationship to the clinicopathological features. MATERIALS AND METHODS: A retrospective, multi-institutional French study was conducted on 401 patients who underwent radical nephroureterectomy for non-metastatic UUT-UC. Hydronephrotic status was determined using preoperative imaging reports. Univariate and multivariate analyses were conducted to identify factors associated with survival. RESULTS: Preoperative hydronephrosis was present in 74 patients. Median follow-up was 26 months. Hydronephrosis was associated only with ureteral localisation (p < 0.001). No difference was observed in 5-year cancer-specific survival (CSS) between the hydronephrosis group (80.1 %) and the no hydronephrosis group (83.6 %) (p > 0.05). Only age (p = 0.02) and pT stage (p = 0.01) were independent predictors of CSS. Hydronephrosis was not a significant predictor of CSS in the univariate and multivariate analyses (p = 0.87 and p = 0.66). No significant difference was observed for 5-year metastasis-free survival (MFS) between the hydronephrosis group (69.8 % ± 6.6 %) and the no hydronephrosis group (80.5 % ± 3 %) (p = 0.052). Hydronephrosis was not a significant predictor of MFS in the univariate and multivariate analyses (p = 0.16 and p = 0.36). Multifocality (p = 0.02), pT stage (p < 0.001) and positive surgical margins (p = 0.02) were independent predictors of MFS. For the pelvic tumours subgroup, hydronephrosis was an independent predictor of MFS (p = 0.01) but not CSS (p = 0.86). CONCLUSION: Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal tumours appear to have a worse prognosis than ureteral tumours.