Abstract
ABSTRACTAim To assess if calibration of the ureteropelvic junction (UPJ) using a high-pressure balloon inflated at the UPJ level in patients with suspected crossing vessels (CV) could differentiate between intrinsic and extrinsic stenosis prior to laparoscopic vascular hitch (VH).Materials and Methods We reviewed patients with UPJO diagnosed at childhood or adolescence without previous evidence of antenatal or infant hydronephrosis (10 patients). By cystoscopy, a high-pressure balloon is sited at the UPJ and the balloon inflated to 8-12 atm under radiological screening. We considered intrinsic PUJO to be present where a ‘waist’ was observed at the PUJ on inflation of the balloon and a laparoscopic dismembered pyeloplasty is performed When no ‘waist’ is observed we considered this to represent extrinsic stenosis and a laparoscopic VH was performed. Patients with absence of intrinsic PUJ stenosis documented with this method are included for the study.Results Six patients presented pure extrinsic stenosis. The mean age at presentation was 10.8 years. Mean duration of surgery was 99 min and mean hospital stay was 24 hours in all cases. We found no intraoperative or postoperative complications. All children remain symptoms free at a mean follow up of 14 months. Ultrasound and renogram improved in all cases.Conclusion When no ‘waist’ is observed we considered this to represent extrinsic stenosis and a laparoscopic VH was performed. In these patients, laparoscopic transposition of lower pole crossing vessels (‘vascular hitch’) may be a safe and reliable surgical technique.
Highlights
The incidence of crossing vessels (CV) in the etiology of Ureteropelvic Junction Obstruction (UPJO) in children ranges from 11% to 15% [1], but has been reported as frequently as 58% in a series of older children with symptomatic UPJO and normal prenatal ultrasonography [2]
We propose that calibration of the ureteropelvic junction (UPJ) be performed using a high-pressure balloon inflated at the UPJ level in patients with suspected CV to differentiate between intrinsic and extrinsic stenosis
We reviewed patients with UPJO diagnosed at childhood or adolescence without previous evidence of antenatal or infant hydronephrosis
Summary
The incidence of crossing vessels (CV) in the etiology of Ureteropelvic Junction Obstruction (UPJO) in children ranges from 11% to 15% [1], but has been reported as frequently as 58% in a series of older children with symptomatic UPJO and normal prenatal ultrasonography [2]. This is especially common in children who report a history of intermittent abdominal pain coincident with abundant fluid ingestion and preserved renal function. The main limitation of vascular hitch is the difficulty in distinguishing between intrinsic and extrinsic stenosis in order to select the least invasive surgical option.
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