Contributions of the Retroperitoneoscopy to the Diagnose of the Ureteropelvic Junction Obstruction in Children: New Surgical Alternatives to Conventional Pyeloplasty

Abstract

PURPOSE To assess:The correlation between pre and post-retroperitoneoscopy diagnose of the ureteropelvic junction obstruction (UPJO) causes. The impact of Retroperitoneoscopy on the surgical technique used for the resolution of the extrinsic UPJO. MATERIAL AND METHODS Between 2004 and 2006 we have treated 14 patients, with congenital hydronephrosis due to UPJO, by retroperitoneoscopic approach. The mean age of surgery was 22 months (range between 3 months and 12 years). In all patients preoperative study included: ultrasound (US), cystography, diuretic renography and renal scintigraphy; and uro-angio-Magnetic Resonance in 10. Preoperative diagnose was: intrinsic UPJO in 10 patients and extrinsic UPJO due to crossing polar vessels in 4. The mean postoperative follow-up has been 16 months (range between 8 and 20 months). The postoperative outcome has been evaluated by US, renography and renal scintigraphy. RESULTS After -retroperitoneoscopy the diagnose became: intrinsic UPJO in 6, and extrinsic UPJO in 8, due to posterior polar vessel in 2, peri-UPJ fibrosis in 4, and anterior polar vessel in 2. UPJO is due to extrinsic causes in 57% of the patients. These findings resulted in the variation of the surgical technique in 6 patients (42.5%). We performed video-assisted ureteropyeloplasty in 6, pyelopyeloplasty in 2, ureterolysis in 4, and pelvic transposition and pexia in 2. There were no intra - or postoperative complications. The average length of stay was 1,6 days. The postoperative result was improvement of the obstruction in 100%, without differences between those who underwent some kind of plastia from those who did not. CONCLUSIONS Retroperitoneoscopy is an effective method for diagnose and minimally invasive treatment of the ureteropelvic junction obstruction. Retroperitoneoscopy raises new surgical alternatives to ureteropyeloplasty. Surgical technique should be based on Retroperitoneoscopical findings.