Transposition of Lower Polar Vessels: An Operative Approach to Hydronephrosis

Brosig, W; Kollwitz, A. A.

doi:10.1016/s0022-5347(17)65361-8

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Hellstrom (1949) described a method in which sutures were passed through the perivascular connective tissue. Brosig & Kollwitz (1961) used a flap of peripelvic fat for the same purpose and the nephioplication operation of Stewart (1947), although superficially very different, depends on the same principle, but, in our opinion, is more suitable for the intrarenal type of hydronephrosis (Fig 2).…”

Section: Discussionmentioning

confidence: 87%

Results of Treating Hydronephrosis by the Chapman Technique

McCreadie

1968

Proceedings of the Royal Society of Medicine

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Section: Discussionmentioning

confidence: 87%

Results of Treating Hydronephrosis by the Chapman Technique

McCreadie

1968

Proceedings of the Royal Society of Medicine

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“…Subsequently, Hellstrom et al [ 7 ] described upward transition of the LCPV by suturing the adventitia of the crossing artery to the anterior pelvic wall. Brosig and Kollwitz [ 8 ] introduced refinements of the original procedure in terms of hitching the LPCV and subsequent fixation to the front wall of the renal pelvis. Chapman [ 9 ] postulated to place the LPCV in a tunnel formed by invagination of the anterior wall of the renal pelvis, thereby hitching the LPCV.…”

Section: Introductionmentioning

confidence: 99%

Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction

et al. 2021

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Chapman and Hellstrom techniques are typically employed to transpose renal lower pole crossing vessels (LPCVs). Both procedures have certain limitations. We investigated the midterm outcomes in pediatric patients in whom LPCV-induced ureteropelvic junction obstruction was treated with either dismembered Anderson-Hynes pyeloplasty or upward transposition coupled with a new technique to fix the LPCV. We retrospectively compared Anderson-Hynes pyeloplasty to the new technique in terms of outcome. LPCV transposition was considered feasible in patients in whom the diuretic loading test revealed a decrease in the pelvic volume after correction of vascular compression as well as absence of structural changes in the ureteropelvic junction (UPJ) and hemodynamic compromise of the lower renal pole. The fascial flap was passed below the LPCV to form a “hammock”. The free edge of the flap was sutured to its base. Group 1 consisted of 102 (69.9%) patients (median age: 7.9 years) undergoing dismembered Anderson-Hynes pyeloplasty, while group 2 included 44 (30.1%) patients (median age: 8.4 years) treated with upward transposition and the new technique to fix the LPCV. No intra-operative complications or conversions occurred in either group. Redo-pyeloplasty was performed in 3 (2.9%) children of group 1 and 1 (2.3%) child of group 2. Renal ultrasonography conducted 12 months after surgery revealed similar anteroposterior diameters of the renal pelvis in groups 1 (7.9 ± 8.1 mm) and 2 (6.0 ± 2.9 mm). Patients in both groups showed a non-significant median increase in differential renal function at follow-up after at least 1 year after surgery (group 1: 36% [33.3; 40.5] vs 36.5% [35.3; 41.0]; group 2: 41% [37.5; 46.0] vs 43% [39; 46]). In our patients, the new technique for laparoscopic or open fixation of the obstructing vessel after transposition was effective, reproducible, and devoid of limitations typical for the Chapman and Hellstrom techniques. We recommend Anderson-Hynes pyeloplasty in children with a history of hydronephrosis diagnosed antenatally, recurrent abdominal pain, intra-operative absence of peristalsis across the UPJ, high location of the UPJ at the renal pelvis, or intra-operative absence of volume reduction of the renal pelvis upon furosemide testing.

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“…PUJ obstruction in the older child may have an extrinsic aetiology due to a lower pole crossing vessel. The association was first described by von Rokitansky [1] in 1842 [2]. The ‘gold standard’ in the management of most intrinsic and extrinsic PUJ obstructions has been a dismembered pyeloplasty as described by Anderson and Hynes [3] in 1949.…”

Section: Introductionmentioning

confidence: 99%