title: Further experience with the vascular hitch (laparoscopic transposition of lower pole crossing vessels): an alternate treatment for pediatric ureterovascular ureteropelvic junction obstruction.
abstract: OBJECTIVE
  Standard treatment for ureterovascular ureteropelvic junction obstruction has been dismembered pyeloplasty. We previously reported the alternative technique of laparoscopic transposition of lower pole vessels (the vascular hitch) in pediatric patients. This report is an update of this select group of pediatric patients with intermediate followup.
  
  
  METHODS
  Patients underwent diagnostic renal sonography and (99m)technetium-mercaptoacetyltriglycine diuretic renography with additional magnetic resonance angiography in candidate patients. Radiographic criteria included moderate hydronephrosis with no caliceal dilatation and a well preserved cortex, poor renal drainage with preserved split function and lower pole crossing vessels. Intraoperative criteria included a normal ureter and ureteropelvic junction with peristalsis. Postoperatively patients were followed clinically, and with renal sonography and (99m)technetium-mercaptoacetyltriglycine renography at 1 and 2 months, respectively. Success was defined as symptom resolution with radiographic improvement in hydronephrosis and drainage with preserved renal function.
  
  
  RESULTS
  Nine boys and 11 girls 7 to 16 years old (mean age 12.5) underwent laparoscopic transposition of crossing vessels, including 3 with da Vinci robot assistance. Mean operative time was 90 minutes (range 47 to 140). Median hospital stay was 24 hours. No ureteral stents or urethral catheters were placed intraoperatively. At a mean followup of 22 months (range 12 to 42) 19 of 20 patients (95%) had been successfully treated. One patient who had recurrent pain underwent successful laparoscopic pyeloplasty.
  
  
  CONCLUSIONS
  At intermediate followup the laparoscopic vascular hitch procedure has been successful in treating patients with ureterovascular ureteropelvic junction obstruction. In these select patients this technique offers a feasible and durable alternative to standard dismembered pyeloplasty. Ongoing evaluation continues to ensure that the promising results endure.
authors: Department of Pediatric Urology, Great Ormond Street Hospital for Children, London, United Kingdom.
authors: Mohan S
authors: MS
authors: Gundeti
authors: W Stuart
authors: WS
authors: Reynolds
authors: Patrick G
authors: PG
authors: Duffy
authors: Imran
authors: I
authors: Mushtaq
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000209:etiology; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D019275:Radiopharmaceuticals; D012371:Robotics; D017263:Technetium Tc 99m Mertiatide; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery*; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide