Laparoscopic Management of Ureteropelvic Junction Obstruction by Division of the Aberrant Vein and Cephalad Relocation of the Crossing Artery: A Long-Term Follow-Up of 42 Cases

Abstract

It was intended to demonstrate the update report of our experience with laparoscopic management of ureteropelvic junction obstruction by division of the aberrant vein and cephalad relocation of the crossing artery in a large group of patients with long-term follow-up. Three hundred and twenty-nine patients were candidate to undergo laparoscopic transperitoneal ureteropelvic junction obstruction management from June 2001 to March 2009. Intraoperatively, lower pole crossing vessels were identified in 117 patients (35.5%). After division of the aberrant vein, the crossing artery was relocated cephalad and fixed to peripelvic tissue. Renal pelvic emptying with proper pyeloureteral peristalsis was considered in 71 patients, so neither pyeloplasty nor Double-J stent was fixed for them. Postoperative outcomes were assessed with intravenous urography and/or diethylene triamine pentaacetic acid-diuretic renal scan. Of the 71 patients who underwent this laparoscopic approach, 42 were completely followed over a long-term period. The mean age of patients was 27 (7-69) years. The mean operative duration was 133 (55-185) minutes and blood loss was negligible. The mean hospital stay was 2.8 (1-7) days and mean follow-up was 29 (3-84) months. Overall success rate was 90% and recurrence of obstruction was noted in two patients. No significant complications were observed. Cephalad relocation of the lower pole crossing artery after division of the crossing vein in selected cases could be an ideal alternative for dismembered pyeloplasty with noticeable outcomes in long-term follow-up.