The retroperitoneal laparoscopic Hellström technique for pelvi-ureteric junction obstruction from a crossing vessel.
OBJECTIVE
To report our experience with the treatment of pelvi-ureteric junction obstruction (PUJO) using the retroperitoneal laparoscopic Hellström (RLH) technique to relocate the crossing vessel.


METHODS
We used the RLH technique selectively in eight patients with PUJO from an aberrant crossing vessel, according to observations during surgery. The crossing vessel was mobilized and embedded in the generous pelvic wall with 4-0 polyglactin sutures to relieve the PUJO. Follow-up studies included intravenous urography, ultrasonography and renal functional scintigraphy at 1 month after surgery and every 3 months thereafter.


RESULTS
The mean (range) operative duration was 45 (40-60) min; the blood loss was negligible. Crossing vessels were identified to be anterior to the renal pelvis in two patients and posterior in six. The hospital stay after surgery was 5 (4-7) days. No paregoric was required after surgery. The collecting systems were intact and no JJ stent was required in any patient. The mean (range) follow-up was 13.6 (12-15) months. In all patients the obstruction was resolved or significantly improved, and there were no complications, e.g. urine leakage and infection. A long-term follow-up is mandatory.


CONCLUSIONS
The RLH technique is a minimally invasive alternative for patients with PUJO caused by a crossing vessel. Embedding the crossing vessels in the pelvic wall is feasible and safe for such patients; empirical judgement during surgery is prudent for success.
Zhang
Xu
X
Departments of Urology, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, China. xzhang@tjh.tjmu.edu.cn
Xu
Kai
K
Fu
Bin
B
Zhang
Jun
J
Lang
Bin
B
Ai
Xing
X
Wang
Baojun
B
Shi
Taoping
T
Ma
Xin
X
D000328:Adult; D001165:Arteriovenous Malformations / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000002:abnormalities / Q000098:blood supply / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D012077:Renal Artery / Q000002:abnormalities / Q000601:surgery*; D012082:Renal Veins / Q000002:abnormalities / Q000601:surgery*; D012187:Retroperitoneal Space; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*