title: Laparoscopic cranial plication in pelviureteral junction obstruction by aberrant lower pole artery.
abstract: OBJECTIVE
  The standard management for pelviureteral junction (PUJ) obstruction is a laparoscopic dismembered pyeloplasty. We present the initial results of our experience of laparoscopic cranial transposition of lower-pole crossing vessels in the management of adult PUJ obstruction where crossing vessels were identified.
  
  
  METHODS
  All patients during the last 2 years who presented with PUJ obstruction caused by crossing lower-pole vessels underwent a laparoscopic transposition of the artery to a more cranial position and, in fact, plicated within the renal pelvis well above the PUJ to reduce the size of the baggy renal pelvis. Patients were followed up postoperatively with mercaptoacetyl triglycine renography as well as clinical symptom review at 3 months, 6 months, and then yearly.
  
  
  RESULTS
  Seven patients have undergone this procedure so far. The mean follow-up period at present is 14 months (range 8-22 months). All patients had a nonobstructive renogram curve at 3 months and 6 months. One patient has had renography at 22 months, which still shows a nonobstructive drainage pattern. All patients have had a resolution of their pain and urinary tract infections. The mean operative time, including the retrograde study and Double-J stent insertion was 121 minutes (range 110-131 min) with a mean blood loss of 30 mL. The mean hospital stay was 2 days. There were no complications.
  
  
  CONCLUSIONS
  Although currently the number of patients is small and follow-up is short, this procedure appears to be effective in relieving both symptoms and obstruction in patients with lower-pole crossing vessels. Other benefits include shorter operative time, less blood loss, as well as no risk of anastomotic stricture and urine leak when compared with a dismembered pyeloplasty. The Double-J stent can be removed within a few days (typically 5 in our hands) or even shorter where logistically feasible. This reduces stent-related complications.
authors.affiliation: Endourology and Stone Services, Barts and The London NHS Trust, London, United Kingdom. Junaido@aol.com
authors.forename: Junaid
authors.initials: J
authors.lastname: Masood
authors.forename: Ali
authors.initials: A
authors.lastname: Panah
authors.forename: Faruquz
authors.initials: F
authors.lastname: Zaman
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Papatsoris
authors.forename: Noor
authors.initials: N
authors.lastname: Buchholz
authors.forename: Islam
authors.initials: I
authors.lastname: Junaid
mesh_terms: D006801:Humans; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D019990:Perioperative Care; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015607:Stents; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*