Laparoscopic vascular relocation: alternative treatment for renovascular hydronephrosis in children

Abstract

Laparoscopic vascular relocation is an unconventional technique in carefully selected patients with PUJO. It obviates disrupting an intrinsically normal PU junction and treats the cause rather than the effect. Our intermediate-term results are encouraging and further long-term assessment is needed.

Hydronephrosis: Comparison of extrinsic vessel versus intrinsic ureteropelvic junction obstruction groups and a plea against the vascular hitch procedure

“…In centers performing color Doppler routinely, the detection rate of the vessel may be high as seen in Hacker et al's [6] series where 25 of the 28 cases were diagnosed correctly. However, it is operator dependent and has a learning curve [7]. Retrograde pyelography may help in delineating a normal ureter up to the sharp cut-off at the UPJ [7].…”

“…However, it is operator dependent and has a learning curve [7]. Retrograde pyelography may help in delineating a normal ureter up to the sharp cut-off at the UPJ [7]. However, it does not give any anatomical or functional information about the kidney and increases operative time apart from the small risk of injury during access.…”

“…Nerli et al's [9] failed vascular hitch procedure is described in a 9-yearold female. Singh et al [7] reported laparoscopic relocation of lower pole vessels in 10 boys and nine girls. This higher incidence of CV in female children has not been emphasized in the literature so far.…”

“…Careful visual inspection and peristalsis across the UPJ has been described to rule out coexisting intrinsic obstruction [4,9]. However, one of 19 patients in one study where this technique was used did not show improvement in drainage on a MAG3 scan [7]. Another is to dissect and lift the aberrant vessel off the pelvis followed by intravenous hyperhydration and diuretic injection, which also does not eliminate the possibility of intrinsic obstruction [3].…”

Differences between intrinsic and extrinsic ureteropelvic junction obstruction related to crossing vessels: histology and functional analyses

“…Whereas there are several reports, meta-analyses, and even one Cochrane review concerning the safeness and effectiveness of laparoscopic or roboticassisted dismembered pyeloplasty in children [26], and the advantage of definitive procedure like NDMP and DMP over endopyelotomies in adults with extrinsic UPJO [11], only few reports about vascular hitch procedures in children are available (Table 4) [12,[27][28][29][30][31][32][33]. However, even in some of these reports, the analysed patient' cohorts consisted of mixed ages-children and adults [12,29,30].…”