High-pressure balloon assessment of pelviureteric junction prior to laparoscopic “vascular hitch”

Abstract

Aim To assess if calibration of the ureteropelvic junction (UPJ) using a high-pressure balloon inflated at the UPJ level in patients with suspected crossing vessels (CV) could differentiate between intrinsic and extrinsic stenosis prior to laparoscopic vascular hitch (VH).Materials and Methods We reviewed patients with UPJO diagnosed at childhood or adolescence without previous evidence of antenatal or infant hydronephrosis (10 patients). By cystoscopy, a high-pressure balloon is sited at the UPJ and the balloon inflated to 8-12 atm under radiological screening. We considered intrinsic PUJO to be present where a ‘waist’ was observed at the PUJ on inflation of the balloon and a laparoscopic dismembered pyeloplasty is performed When no ‘waist’ is observed we considered this to represent extrinsic stenosis and a laparoscopic VH was performed. Patients with absence of intrinsic PUJ stenosis documented with this method are included for the study.Results Six patients presented pure extrinsic stenosis. The mean age at presentation was 10.8 years. Mean duration of surgery was 99 min and mean hospital stay was 24 hours in all cases. We found no intraoperative or postoperative complications. All children remain symptoms free at a mean follow up of 14 months. Ultrasound and renogram improved in all cases.Conclusion When no ‘waist’ is observed we considered this to represent extrinsic stenosis and a laparoscopic VH was performed. In these patients, laparoscopic transposition of lower pole crossing vessels (‘vascular hitch’) may be a safe and reliable surgical technique.

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

“…Miranda [23] used the Whitaker test, consisting in the percutaneous positioning of a pelvic needle for the measurement of pelvic pressure after vessels mobilization. Parente calibrated UPJ using a high-pressure balloon inserted by cystoscopy, demonstrating intrinsic component by the observation of a waist in the balloon profile [24]. Despite the existence of multiple tests, we believe that the use of invasive procedures is not necessary for decision-making because of potential related injuries.…”

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

“…In all patients, hydronephrosis had resolved at postoperative follow-up; in 1 patient who was lost to follow-up, this could not be confirmed. [ 22 ] Similarly, Parente et al [ 23 ] extended the known criteria for patient selection by an intra-operative test with retrograde catheter insertion into the UPJ zone for balloon dilation in order to identify internal causes of UPJO. The authors stipulated that development of a “waist” in the UPJ zone after inflating the balloon under a pressure of 8 to 12 atm.…”

“…is indicative for a combination of external and internal causes of obstruction. They recommended upward transposition of LPCV exclusively in UPJO children who did not exhibit the “waist” sign upon balloon dilation of the UPJ [23] . The authors concluded that the additional endoscopic procedure did not prolong the time of intervention, nor did it affect the rate of postoperative complications or length of hospital stay (LOS).…”

Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?

“…Because of the small number of patients, this study is less valuable. Parente et al calibrated UPJ using a high-pressure balloon inserted by cystoscopy and inflated at the UPJ level in 10 patients with suspected CV ( 20 ). They considered intrinsic obstruction to be present where a “waist” was observed at the UPJ on inflation of the balloon and a laparoscopic dismembered pyeloplasty was performed.…”