title: Retroperitonoscopic pyelopexy for pelviureteral junction obstruction with crossing vessel in adolescents: Hellstrom principle revisited.
abstract: OBJECTIVE
  To present our new approach using a minimally invasive technique for the management of pelviureteral junction (PUJ) obstruction with a crossing vessel.
  
  
  METHODS
  In December 2009 to December 2011, out of 23 cases of retroperitoneoscopic laparoscopic pyeloplasty, four adolescents presenting with PUJ obstruction due to an aberrant crossing vessel, with intermittent attacks of renal colic and mild dilatation of the renal pelvis and calyces, were operated by retroperitoneoscopic pyelopexy. A retroperitoneoscopic approach was used in all patients using three trocars. After dissection of the PUJ from the anterior crossing vessel, and ensuring good funneling of the PUJ that proved to show mild dilatation, an interrupted 3/0 polyglycolic suture was used to fix the renal pelvis to the psoas muscle away from the crossing vessel (pyelopexy). A retrograde DJ stent was placed at the end of the procedure.
  
  
  RESULTS
  The four patients had a mean age of 18.25 years (16-20): 2 males and 2 females, two right sided and two left sided. Average operative time was 46 min (40-55). All patients were discharged on the same day. No intraoperative complications were encountered. The DJ stent was removed 6 weeks postoperatively. After a mean follow up of 2.125 years (6 months-3 years) no recurrences were observed.
  
  
  CONCLUSIONS
  Retroperitoneoscopic pyelopexy is shown to be a reliable, effective, safe and minimally invasive technique for the management of PUJ obstruction with a crossing vessel in selected cases. Long-term follow up is needed to assess any recurrence or development of complications.
authors: Department of Urology, University of Alexandria, Alexandria, Egypt. Akramassem@me.com
authors: Akram
authors: A
authors: Assem
authors: Mohammed Mohi
authors: MM
authors: Hashad
authors: Haytham
authors: H
authors: Badawy
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D007682:Kidney Pelvis / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014513:Ureter / Q000098:blood supply; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult