Ureterovascular hydronephrosis in children: is pyeloplasty always necessary?
OBJECTIVE
To evaluate the efficacy of the vessel transposition technique in ureterovascular hydronephrosis in children.


METHODS
Over a 25-year period, we treated 111 patients with 112 instances of ureterovascular hydronephrosis. In order to determine the obstructive effect of the vessels, we performed an intraoperative diuretic test. Using this approach, 61 patients judged to have only vascular pyeloureteral junction obstruction underwent vessel transposition. However, 50 patients in whom the intraoperative diuretic test proved doubtful needed pyeloplasty.


RESULTS
Surgical success was achieved in 98% of the patients. Only 1 child treated by vessel transposition had an unsatisfactory outcome which necessitated a subsequent pyeloplasty for persistent hydronephrosis. This was due to a previously unrecognized intrinsic pyeloureteral junction obstruction.


CONCLUSIONS
Based on our clinical experience, the intraoperative diuretic test has proven to be a safe and effective diagnostic tool in children with ureterovascular hydronephrosis. Its use may contribute to treating some cases of ureterovascular hydronephrosis without resorting to pyeloplasty.
Pesce
C
C
Division of Pediatric Surgery, Section of Urology, S. Bortolo Hospital, Vicenza, Italy.
Campobasso
P
P
Costa
L
L
Battaglino
F
F
Musi
L
L
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012077:Renal Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000098:blood supply* / Q000000981:diagnostic imaging; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014567:Urography; D013520:Urologic Surgical Procedures / Q000379:methods