title: High-pressure balloon assessment of pelviureteric junction prior to laparoscopic "vascular hitch".
abstract: OBJECTIVE
  To assess if calibration of the ureteropelvic junction (UPJ) using a high-pressure balloon inflated at the UPJ level in patients with suspected crossing vessels (CV) could differentiate between intrinsic and extrinsic stenosis prior to laparoscopic vascular hitch (VH).
  
  
  METHODS
  We reviewed patients with UPJO diagnosed at childhood or adolescence without previous evidence of antenatal or infant hydronephrosis (10 patients). By cystoscopy, a high-pressure balloon is sited at the UPJ and the balloon inflated to 8-12 atm under radiological screening. We considered intrinsic PUJO to be presente where a 'waist' was observed at the PUJ on inflation of the balloon and a laparoscopic dismembered pyeloplasty is performed When no 'waist' is observed we considered this to represent extrinsic stenosis and a laparoscopic VH was performed. Patients with absence of intrinsic PUJ stenosis documented with this method are included for the study.
  
  
  RESULTS
  Six patients presented pure extrinsic stenosis. The mean age at presentation was 10.8 years. Mean duration of surgery was 99 min and mean hospital stay was 24 hours in all cases. We found no intraoperative or postoperative complications. All children remain symptoms free at a mean follow up of 14 months. Ultrasound and renogram improved in all cases.
  
  
  CONCLUSIONS
  When no 'waist' is observed we considered this to represent extrinsic stenosis and a laparoscopic VH was performed. In these patients, laparoscopic transposition of lower pole crossing vessels ('vascular hitch') may be a safe and reliable surgical technique.
authors.affiliation: Departamento de Urología Pediátrica, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Parente
authors.affiliation: Departamento de Urología Pediátrica, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Jose-Maria
authors.initials: JM
authors.lastname: Angulo
authors.affiliation: Departamento de Urología Pediátrica, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Romero
authors.affiliation: Departamento de Urología Pediátrica, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Burgos
authors.affiliation: Departamento de Urología Pediátrica, Hospital Universitario Gregorio Marañón, Madrid, España.
authors.forename: Ruben
authors.initials: R
authors.lastname: Ortiz
mesh_terms: D000293:Adolescent; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D002138:Calibration; D002648:Child; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D007682:Kidney Pelvis / Q000098:blood supply* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011312:Pressure; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*