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BACKGROUND:
The transposition of lower pole crossing vessels (LPCV) has been described as an alternative to dismembered pyeloplasty for the treatment of ureterovascular pelvi-ureteric junction obstruction (PUJO). Our aim was to report on the long term follow-up of children after laparoscopic transposition of LPCV.
METHODS:
Retrospective analysis of 70 children consecutively treated by laparoscopic transposition of LPCV at 3 university institutions. Candidate patients were selected on the basis of clinical history, renal US, and preoperative MAG-3. Selection criteria included presence of LPCV with moderate hydronephrosis, poor drainage and intra-operative normal PUJ and ureter peristalsis. Children were followed-up clinically with renal US and postoperative MAG-3. Success was defined by symptoms resolution with improvement in hydronephrosis and drainage.
RESULTS:
Seventy children presenting with flank pain, hydronephrosis SFU grade 1 or 2, impaired drainage on MAG-3 and LPCV (age 8.3 years, range 2.75-16) were selected. Procedures were performed through transperitoneal laparoscopy (n=42) or robotic assisted (n=28). Operative time was 120 min [60-280], and length of hospital stay was 2 days [1-17]. With a median follow-up of 45 months [12-103], outcome was successful in 65/70 patients (93%). There were 3 failures (4%) in children presenting recurrent pain and increasing hydronephrosis during early postoperative course, who eventually underwent dismembered pyeloplasty for an undiagnosed intrinsic PUJ obstruction. Two children had improved hydronephrosis and symptoms, but still showed impaired drainage on MAG-3 and are closely followed-up.
CONCLUSIONS:
With a long postoperative follow-up, the vascular hitch procedure, either robotic or laparoscopic, has been successful in treating a selected group of children with obstructive LPCV, and represents a safe and reliable alternative to standard dismembered pyeloplasty in the absence of intrinsic PUJO.