PurposeThe authors examined the number of interstitial cells of Cajal-like cells (ICC-LCs) in obstructed ureteropelvic junction (UPJ) in comparison with normal UPJ specimens and age-related changes.Materials and methodsA total of 20 human formalin fixed, paraffin-embedded specimens of intrinsic UPJO from children at the mean age of 8.1 years (age range: 8 months–16.8 years) and 5 control samples from children at the mean age of 2.3 years (range 2.4 months–7.4 years) were investigated immunohistochemically for the expression of c-kit proto-oncogene by light microscopy with computerized image analysis. The results were examined by Fisher’s exact test, Yates’ chi-square test, and t test for Pearson’s correlation coefficient. A P value less than 0.05 was considered statistically significant.ResultsThe number of ICC-LCs-dense fields was significantly higher in UPJO specimens in comparison with the normal group (P = 0.0004). The number of ICC-LCs-sparse fields was significantly lowered in UPJO specimens in comparison with the normal group (P = 0.0122). There was no significant difference in the number of ICC-LCs-medium fields in obstructed and normal UPJ specimens. The number of ICC-LCs was decreasing significantly with increasing age of the patients with UPJO (P = 0.0038).ConclusionsThe higher density of c-kit-positive ICC-LCs in UPJ may manifest the compensation of altered peristalsis in UPJO. The number of ICC-LCs-dense fields decreasing with age may show the failure of compensation and regression of the compensatory changes.

Objectives: Assessment of the efficacy of intraoperative diagnosis between extrinsic and intrinsic UPJO in children. Assessment of the efficacy of laparoscopic vascular-hitch procedure in UPJO caused by lower pole crossing vessels (CV).Materials and Methods: Between 2008 and 2017, 47 laparoscopic procedures were performed with the CV discovered intraoperatively. CV were translocated cephalad, and the UPJ was carefully inspected. The Chapman's vascular hitch procedure was accomplished in the case of decreasing sizes of the pelvis and clear, visible peristalsis of the UPJ (31 patients). In the other cases, Anderson–Hynes (A-H) pyeloplasty with posterior translocation of the CV was performed (16 patients).Results: The median age at operation was 6 years (range 1–16) in VH and 6 years (range 2–17) in A-H (p = 0.4635). Prenatal dilatation of kidney was diagnosed in 18.7% of VH and 10% of A-H cases (p = 0.5474). Success was achieved in 16 (100%) patients in the A-H and in 29 (93.54%) in the VH groups. Two patients (6.5%) in VH required repeated surgery because of a misdiagnosed intrinsic obstruction. Median operation time in VH was 80 min (range 40–105) and was 105 (range 70–225) in A-H (p < 0.05).Conclusions: The intraoperative selection based on intraoperative pelvis and UPJ appearance after vessel transposition is sufficient in majority of cases. Laparoscopic vascular hitch seems to be effective and safe procedure, but can only be performed on carefully selected patients. In case of misdiagnosis, reoperation is possible with the same laparoscopic access.

The aim of the study was to compare the efficacy of laparoscopic versus open dismembered pyeloplasty in children. Material and methods: Two hundred and twenty-six Anderson-Hynes pyeloplasties were performed, out of which 131 by open access (OP) and 95 by laparoscopic access (LP). Retrospective analysis of data was performed. The median follow-up was 3 years for LP patients and 6 years for OP patients (p < 0.05). Results: Success was achieved in 87 (91.57%) patients who had LP surgeries and in 121 (91.7%) patients who had OP (p > 0.05). Eight patients in the LP group and nine in the OP group required another surgery because of recurrent UPJO, and one patient in the OP group required a nephrectomy. The median operating time was 125 min (range: 70-225) for LP surgeries and 90 (40-200) for OP surgeries (p < 0.05). In the last 30 LP procedures, operation time decreased to a median of 95 min. Improvement in ultrasound analysis of the kidney was achieved in 89.06% of patients who had LP and 82.35% of patients who had OP. A stable or better function of the kidney in diuretic renography was achieved in 87.5% of patients in the LP group and 96.15% of patients in the OP group. Conclusions: Laparoscopic and open pyeloplasty is a highly efficient procedure employed to treat UPJO in children with comparable success rates in both groups. In experienced hands, it is possible to reduce the LP operation time to that comparable to the OP group.

Detection rate of crossing vessels in pediatric hydronephrosis-transperitoneal laparoscopy versus open lumbotomy.