Detection rate of crossing vessels in pediatric hydronephrosis: Transperitoneal laparoscopy versus open lumbotomy.
BACKGROUND
A bundle of crossing vessels (CV) supplying the lower pole of the kidney and causing mechanical obstruction of the ureteropelvic junction (UPJ) has been the subject of many discussions. During pyeloplasty, it is possible to overlook the CV. This may result in recurrent dilatation of the kidney and the need for re-surgery.


OBJECTIVES
To compare the detection rate of CV in UPJ obstruction (UPJO) depending on the operational access applied (transperitoneal laparoscopy (LAP) vs open lumbotomy (OPEN)). Assessment of features that could indicate the presence of CV.


MATERIAL AND METHODS
Two hundred and forty-six pediatric pyeloplasties were performed between January 2006 and July 2017 in the Department of Pediatric Surgery and Urology at the Wroclaw Medical University, Poland - 111 out of them by LAP and 135 by OPEN, on 98 girls and 148 boys. A retrospective analysis of the patient records for the detection of CV and characteristics of the CV before surgery was performed.


RESULTS
Intraoperative CV causing obstruction of the UPJ in the LAP group were recognized in 34.2% (n = 38) of the patients, and within the OPEN group in 12.5% (n = 17) (p < 0.0001); 90% (n = 27) of patients with the diagnosed CV did not show congenital hydronephrosis. In 68% (n = 21) of the patients there were cases of recurrent renal colic. The presence of CV was suspected in 7.2% of kidney ultrasounds and in 12.5% in computed tomography (CT) urograms.


CONCLUSIONS
The detection rate of CV in UPJO is statistically higher in LAP access than in open retroperitoneal lumbotomy. The distinguishing features of patients with CV are the lack of prenatal diagnosis for hydronephrosis and the presence of pain in the lumbar region.
['Polok|Marcin|M|', 'Borselle|Dominika|D|', 'Toczewski|Krystian|K|', 'Apoznański|Wojciech|W|', 'Patkowski|Dariusz|D|']
D002648:Child D005260:Female D006801:Humans D006869:Hydronephrosis D007682:Kidney Pelvis D010535:Laparoscopy D008297:Male D011044:Poland D012189:Retrospective Studies D014513:Ureter D014517:Ureteral Obstruction D013520:Urologic Surgical Procedures
crossing vessels hydronephrosis pyeloplasty ureteropelvic junction obstruction vascular hitch