title: Lower pole vessels in children with pelviureteric junction obstruction: laparoscopic vascular hitch or dismembered pyeloplasty?
abstract: OBJECTIVE
  To choose between laparoscopic "vascular hitch" (VH) and dismembered pyeloplasty (DP) in treatment of aberrant lower pole crossing vessels potentially responsible for pelviureteric junction obstruction (PUJO) in older children.
  
  
  METHODS
  Retrospective study of 19 patients treated laparoscopically for PUJO. Based on videos of the procedures, we studied the anatomical relationship between the renal pelvis, the pelviureteric junction, and the aberrant vessels.
  
  
  RESULTS
  Eight patients had laparoscopic VH and 11 had DP. All patients with DP needed drainage. In the VH group, 7/8 patients were asymptomatic and had decreased pelvic dilation. Half of them accepted MAG3 scintigraphy, and in these patients the obstructive syndrome disappeared completely. The last patient in this group was lost to follow-up. We observed three anatomical variations in the location of polar vessels: type 1 (in front of the dilated pelvis), type 2 (in front of the pelviureteric junction), type 3 (under the pelviureteric junction, resulting in ureteral kinking).
  
  
  CONCLUSIONS
  Laparoscopic VH is a simple technique involving no urinary anastomosis or drainage, but we cannot guarantee that the crossing vessels are the sole etiology for PUJO. Following our experience, only patients with type 3 anatomical variations and with a normal pelviureteric junction should be proposed for VH.
authors.affiliation: University Hospital of Strasbourg, Faculty of Medicine of Strasbourg, Strasbourg, France. schneider.an@orange.fr
authors.forename: A
authors.initials: A
authors.lastname: Schneider
authors.forename: C Gomes
authors.initials: CG
authors.lastname: Ferreira
authors.forename: C
authors.initials: C
authors.lastname: Delay
authors.forename: I
authors.initials: I
authors.lastname: Lacreuse
authors.forename: R
authors.initials: R
authors.lastname: Moog
authors.forename: F
authors.initials: F
authors.lastname: Becmeur
mesh_terms: D000293:Adolescent; D001808:Blood Vessels / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000098:blood supply / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D014513:Ureter / Q000098:blood supply / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*