Lower pole vessels in children with pelviureteric junction obstruction: Laparoscopic vascular hitch or dismembered pyeloplasty?

Schneider, Anne; Ferreira, Cindy Gomes; Delay, Christophe; Lacreuse, I.; Moog, R.; Baudin, François

doi:10.1016/j.jpurol.2012.07.005

Cited by 48 publications

(51 citation statements)

References 10 publications

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“…Our result comparing well published data on the transmesocolic approach may provide shorter operation time due to very limited tissue dissection (153 vs. 177 min; p = 0.04) [31]. In our series, aberrant crossing vessel was observed as the cause of UPJO in 12 (7.84%) patients; all of them preferred dismembered pyeloplasty versus vascular hitch, because vascular hitch cannot guarantee that the crossing vessels are the sole etiology for UPJO [32]. Incidence of postoperative complications in LP varies from 0 to 22% of patients, with a conversion and reoperation rate of 0-17 and 0-7.5%, respectively [32].…”

Section: Discussionsupporting

confidence: 81%

“…In our series, aberrant crossing vessel was observed as the cause of UPJO in 12 (7.84%) patients; all of them preferred dismembered pyeloplasty versus vascular hitch, because vascular hitch cannot guarantee that the crossing vessels are the sole etiology for UPJO [32]. Incidence of postoperative complications in LP varies from 0 to 22% of patients, with a conversion and reoperation rate of 0-17 and 0-7.5%, respectively [32]. In our series, 3 cases needed open conversation according to difficulties in anastomosis, and 8 patients experienced UPJO after LP and they underwent open pyeloplasty.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Functional Results of Laparoscopic Pyeloplasty in Children: Single Institute Experience in Long Term

Çiftçi

Akın²,

Savaş³

et al. 2016

Urol Int

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Objective: The aim of this study was to evaluate the long-term functional outcomes of laparoscopic pyeloplasty (LP) in children for consecutive cases of single institute. Materials and Methods: Our laparoscopy database was investigated for children in terms of LP between June 2008 and April 2015. All the patients had ureteropelvic junction obstruction (UPJO) and LP was performed. Demographic data including age, gender, side of UPJO, operation time, estimated blood loss (EBL), hospital stay and complications according to Clavien classifications were recorded. Renal ultrasonography and diethylenetriamine penta-acetate (DTPA) scintigraphies were respectively performed 3, 12 and 24 months after surgery. Statistical analyses were performed and p value was accepted as significant at <0.05. Result: Mean follow-up was 34 ± 4.7 months. The mean age was 13 (6-72) months. A total of 153 (110 boys and 43 girls) LP patients enrolled. Of that, 93 (60.78%) LP were in left side and 60 (39.21%) were in right side. Three cases needed open conversation according to difficulties in anastomosis. Aberrant crossing vessel was observed in 12 (7.84%) patients. The mean operation time was 155 ± 21 min and the mean EBL was 22 ± 11.1 ml. The mean hospital stay was 3.4 days. Anastomotic leakage was the common complication (in 13 patients) that was successfully managed conservatively (Clavien 1). Eight patients experienced unsuccessful LP and underwent open pyeloplasty (Clavien 3b). The mean split renal function significantly increased in DTPA scintigraphy in follow-up. The overall success was 91%. Conclusions: The LP procedure can be an effective and safe surgical method for childhood UPJO, specifically in the experienced hands of pioneer centers.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Functional Results of Laparoscopic Pyeloplasty in Children: Single Institute Experience in Long Term

Çiftçi

Akın²,

Savaş³

et al. 2016

Urol Int

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Ellerkamp¹,

Kurth²,

Schmid³

et al. 2015

World J Urol

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“…Other authors assume that there is no imaging method with which the obstructive effect of a vessel on the pyeloureteral junction can be detected because despite detaching and lifting of the vessel (no cutting) with subsequent fixation above the pyeloureteral junction (so-called vascular hitch [30]), the obstruction can remain [31], or because there are cases in which an aberrant vessel is obstructive in the sense of an extrinsic stenosis but there are also histological changes in the pyeloureteral junction that indicate an intrinsic stenosis [32]. These authors therefore recommend performing an intraoperative water load test following immobilization and clamping of the vessel before and after lifting of the vessel to differentiate an extrinsic stenosis caused by the vessel from a stenosis caused by intrinsic factors [32,33] At present, MAG3 scintigraphy is the gold standard for functional preoperative evaluation of an obstruction and was therefore used in our patient group.…”

Section: Discussionmentioning

confidence: 99%

“…These authors therefore recommend performing an intraoperative water load test following immobilization and clamping of the vessel before and after lifting of the vessel to differentiate an extrinsic stenosis caused by the vessel from a stenosis caused by intrinsic factors [32,33] At present, MAG3 scintigraphy is the gold standard for functional preoperative evaluation of an obstruction and was therefore used in our patient group. This method entails radiation exposure and should be perspectively replaced by an adequate functional MRI examination via which the urodynamics of the urinary system can also be evaluated [29].…”

Section: Discussionmentioning

confidence: 99%

Significance of MR Angiography in the Diagnosis of Aberrant Renal Arteries as the Cause of Ureteropelvic Junction Obstruction in Children

Ritter¹,

Götz

Sorge³

et al. 2014

Fortschr Röntgenstr

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!Purpose: To determine the importance of MRI with contrast-enhanced MRA for the detection or exclusion of aberrant or obstructing renal arteries in ureteropelvic junction obstruction in children. Materials and Methods: Key word-based search in RIS database (ureteropelvic junction obstruction/ MRI) and retrospective comparison of arterial findings from preoperative contrast -enhanced MRA and intra-operative inspection. From 2007 to 2013, 19 children with ureteropelvic junction obstruction underwent contrast-enhanced MRA. Based on the results of the MRI scan and MAG3 scintigraphy, the children were referred to surgery (Anderson-Hynes-pyeloplasty). Results: An aberrant renal artery was diagnosed with MRI in 14 of 19 children, and intra-operative inspection confirmed 13 of those 14. In the remaining 5 children, no aberrant vessel could be observed in MRI and this was confirmed intra-operatively in 3 of the 5 cases, while in the remaining 2, an aberrant vessel was found. Of the 14 children with aberrant vessels, 12 underwent surgery due to assumed ureteral obstruction, which was confirmed by surgery in 11 cases. In one case, an aberrant artery was found intra-operatively, but obstruction could not be confirmed. In one of the 14 children, the vessel was found in MRI, but its obstructing character was negated via MRA, which was confirmed intra-operatively. In the diagnosis of aberrant and obstructing renal arteries, contrast-enhanced MRA presents 85 % sensitivity and 80 % specificity, with a positive predictive value of 0.8. Conclusion: MRI with contrast-enhanced MRA is suitable to detect aberrant and obstructing renal arteries. An obstructive effect of the aberrant vessel is to be assumed if the vessel has a close relationship to the ureteropelvic junction and if it is linearly stretched.

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Lower pole vessels in children with pelviureteric junction obstruction: Laparoscopic vascular hitch or dismembered pyeloplasty?

Cited by 48 publications

References 10 publications

Functional Results of Laparoscopic Pyeloplasty in Children: Single Institute Experience in Long Term

Functional Results of Laparoscopic Pyeloplasty in Children: Single Institute Experience in Long Term

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

Significance of MR Angiography in the Diagnosis of Aberrant Renal Arteries as the Cause of Ureteropelvic Junction Obstruction in Children

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