title: Laparoscopic Transposition of Lower Pole Crossing Vessels (Vascular Hitch) in Children with Pelviureteric Junction Obstruction: How to Be Sure of the Success of the Procedure?
abstract: BACKGROUND
  To report a series of children with pelviureteric junction obstruction (PUJO) due to lower polar crossing vessels who underwent laparoscopic vascular transposition. In order to confirm the relief of the obstruction and avoid unnecessary additional procedures, we suggest performing an intraoperative measure of the ureteral opening pressure.
  
  
  METHODS
  From January 2007 and January 2014, 11 children underwent laparoscopy to treat well-documented PUJO by polar vessels. In the first 7 cases, children underwent a careful dissection of the polar vessels that were transposed cranially in the pelvis. In the last 4 cases, a percutaneous needle was inserted into the renal pelvis, and the ureteral opening pressure was obtained intraoperatively, before and after the vascular hitch procedure, in 3 cases. No vascular relocation was necessary except in 1 case with a polar vessel unrelated to the obstruction.
  
  
  RESULTS
  The laparoscopic procedure was feasible in all cases. Median operative time was 90 minutes without intraoperative complications. In the last 3 cases, a decrease in the renal pelvic pressure was demonstrated just after releasing the ureter from the polar vessels, confirming the extrinsic obstruction. In 1 case, the intraoperative pelvic pressure measurement showed that there was no vascular compression but that obstruction was due to renal rotation. During follow-up (range, 12-96 months) all patients reported resolution of their symptoms, nine children showed a decrease in the hydronephrosis grade, and all but one with poor function had improved drainage on diuretic renography.
  
  
  CONCLUSIONS
  Intraoperative measurement of ureteral opening pressure may help to confirm that the vascular hitch procedure has relieved the pelvic obstruction, precluding the need for dismembered procedures. We believe that in some doubtful cases, with the addition of intraoperative pelvic pressure measurement, vascular hitch may be considered a safe procedure to treat selected cases of PUJO in children.
authors.affiliation: Pediatric Geniturinary Surgery Division, Campinas State University , Campinas, Sao Paulo, Brazil .
authors.forename: Marcio Lopes
authors.initials: ML
authors.lastname: Miranda
authors.affiliation: Pediatric Geniturinary Surgery Division, Campinas State University , Campinas, Sao Paulo, Brazil .
authors.forename: Luiz Henrique
authors.initials: LH
authors.lastname: Pereira
authors.affiliation: Pediatric Geniturinary Surgery Division, Campinas State University , Campinas, Sao Paulo, Brazil .
authors.forename: Márcia Alessandra
authors.initials: MA
authors.lastname: Cavalaro
authors.affiliation: Pediatric Geniturinary Surgery Division, Campinas State University , Campinas, Sao Paulo, Brazil .
authors.forename: Patrícia Carvalho
authors.initials: PC
authors.lastname: Pegolo
authors.affiliation: Pediatric Geniturinary Surgery Division, Campinas State University , Campinas, Sao Paulo, Brazil .
authors.forename: Antonio Gonçalves
authors.initials: AG
authors.lastname: de Oliveira-Filho
authors.affiliation: Pediatric Geniturinary Surgery Division, Campinas State University , Campinas, Sao Paulo, Brazil .
authors.forename: Joaquim Murray
authors.initials: JM
authors.lastname: Bustorff-Silva
mesh_terms: D000293:Adolescent; D001808:Blood Vessels / Q000002:abnormalities; D002648:Child; D002675:Child, Preschool; D004210:Dissection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000209:etiology / Q000601:surgery; D007430:Intraoperative Care; D007668:Kidney / Q000098:blood supply* / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000209:etiology / Q000601:surgery*; D061646:Operative Time; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*