Ureteropelvic junction obstruction in children by polar vessels: Is laparoscopic vascular hitching procedure a good solution? Single center experience on 35 consecutive patients

10^th European Nephrology Conference

October 24-26, 2016 Rome, Italy

Salvatore Fabio Chiarenza, Cosimo Bleve, Maria Luisa Conighi, Valeria Bucci and Francesco Battaglino

San Bortolo Hospital, Italy

Posters & Accepted Abstracts: J Nephrol Ther

Abstract :

Purpose: We report the results of laparoscopic vascular hitching (LVH) in a series of children with ureteropelvic junction obstruction (UPJO) owing to aberrant lower polar crossing vessels (CV). Our aim is to confirm if LVH associated with intraoperative diuretic test (DT) represents a good procedure to treat extrinsic-UPJO by CV. In order to confirm the relief of the obstruction we suggest performing an intraoperative DT. Materials & Methods: In our department from 2006 to 2014, 120 patients were treated for both extrinsic and intrinsic-UPJO. 85 (30 females, 55 males) presented an intrinsic obstruction and underwent dismembered pyeloplasty (AHDP), 61 open, 16 laparoscopic, 8 retroperitoneoscopic. 35 (23 males, 12 females) were studied for a suspected extrinsic-UPJO: 30 were treated with LVH (modified Hellstr�¶m Vascular Hitch). Intraoperative-DT was performed in all patients before and after vessels transpositions confirming the UPJO and eventual relief after the procedure. We included in the study only patients with suspicion of vascular extrinsic-UPJO. Average age at surgery was 7.5 years. Symptoms of presentation were recurrent abdominal/flank pain and hematuria. All patients presented ultrasound (US) detection of hydronephrosis. Preoperative diagnostic studies included: US/Doppler scan, MAG3 renogram, urography, functional magnetic resonance-urography (fMRU) and CT-scan. Results: 28 out 35 patients had a correct pre-operative diagnosis; the remaining needed an intraoperative diagnosis confirmation. Of the 35 patients treated for suspect CV, all had an intraoperative-DT: 30 patients underwent LVH (positive-DT), 3 patients (negative- DT) underwent laparoscopic-AHDP for intrinsic-UPJO; 2 with positive-DT and non-obstructive CV had no surgical treatment. Median operating time was of 95 min with a mean hospital stay of 4 days. At 12-84 months follow-up, 29 patients remained symptomsfree, one needed after two years laparoscopic-AHDP. Conclusions: According to our experience, LVH associated with intraoperative-DT may be considered a safe procedure to treat extrinsic-UPJO by CV in carefully selected patients. In particular, the very low incidence of relapse suggests that in suspicion of extrinsic-UPJO performing intraoperative-DT after CV transposition allows to exclude intrinsic UPJO confirming that LVH procedure has relieved the pelvic obstruction, precluding the need for AHDP.

Biography :

Email: cosimo.bleve@ulssvicenza.it fabio.chiarenza@ulssvicenza.it