Laparoscopic management of ureteropelvic junction obstruction in pediatric patients: a new approach to crossing vessels, crossing vein division, and upward transposition of the crossing artery.
OBJECTIVE
To demonstrate the role of the laparoscopic approach for management of primary ureteropelvic junction obstruction (UPJO) using two different techniques in the pediatric age group.


METHODS
From April 2005 to October 2008, 63 pediatric patients underwent treatment of primary UPJO via a laparoscopic approach. Dismembered pyeloplasty was elected in 56 renal units while nine patients were managed by upward transposition of accessory renal artery after division of accessory renal vein. No JJ stent was required in these nine patients.


RESULTS
Mean age of patients was 61 (2-180) months. Mean operative time was significantly lower in those managed by transposition of aberrant vessels compared with dismembered pyeloplasty. The mean hospital stay was 6.4 (2-14) days for the dismembered technique and 2.1 (1-4) days for the vascular transposition approach. Significant improvement of obstruction was achieved in all of the patients who underwent the modified Hellstrom technique and in 92.81% of the renal units undergoing dismembered pyeloplasty.


CONCLUSIONS
The technique of laparoscopic transposition of crossing renal artery without violating collecting system may have a role in minimally invasive management of UPJO in selected pediatric patients. Further research with larger samples and a longer follow-up period is required.
Simforoosh
Nasser
N
Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center (UNRC), Shahid Beheshti University, M.C. (SBMU), No#101, Boostan 9th St., Pasdaran Ave., Tehran, Islamic Republic of Iran. simforoosh@iurtc.org.ir
Javaherforooshzadeh
Ahmad
A
Aminsharifi
Alireza
A
Soltani
Mohammad Hossein
MH
Radfar
Mohammad Hadi
MH
Kilani
Hossein
H
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012077:Renal Artery / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*