Is the lower pole crossing vessels transposition a valid option for the treatment of extrinsic ureteropelvic obstruction in children? Considerations from a single-centre experience

Abstract

Objective To assess the efficacy of the vascular hitch procedure in extrinsic ureteropelvic junction obstruction (UPJO) by crossing vessels in children, both by open and mini-invasive approach. Methods Retrospective analysis on patients treated by open or mini-invasive vascular hitch during the period 2006-2020. Preoperative imaging included renal ultrasound (US) and functional studies by magnetic resonance or renogram. Crossing vessels obstruction and UPJ anatomy were evaluated at surgery. Success was defined as the resolution of symptoms and improvement of hydronephrosis at US or functional studies. Results Forty-eight patients were included with mean age at surgery of 7.6 years and 25% had an antenatal diagnosis. Aberrant vessels were suspected preoperatively in 72.9%; mean hydronephrosis and renal function were 30.9 mm and 38% respectively. Seven cases were treated by open approach, 37 by laparoscopy and 4 were robotassisted. Mean operative time was 58.3 min and mean hospital stay was 2 days. Mean follow-up was 16.9 months; success rate was 91.6% and 5 patients required secondary surgery. Conclusions Vascular hitch shows to be a safe, feasible and effective alternative to pyeloplasty. Careful pre and intraoperative patients' selection is essential to exclude any intrinsic cause of UPJO. Mini-invasive surgery could be helpful for better evaluation of UPJ anatomy and its relationships with crossing vessels. Complications and secondary surgeries could be related to incorrect patients' selection.

Functional Magnetic Resonance Urography in Ureteropelvic Junction Obstruction: Proposal for a Pediatric Quantitative Score

“…Menon et al identified radiological findings on MRU suspicious for the presence of CV (small, intrarenal, globular pelvis, widening of the pyelo-calyceal junction, and prominent calyceal dilation) ( 38 ). Fiorenza et al found that fMRU was helpful to identify CV in 89.2% of cases ( 39 ).…”