Uretero-pelvic junction obstruction with and without crossing vessels: surgical outcome in a single center experience
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ORIGINAL RESEARCH
Uretero‑pelvic junction obstruction with and without crossing vessels: surgical outcome in a single center experience Michela Cing Yu Wong1,2 · Federico Palo1,2 · Venusia Fiorenza1,2 · Marcello Carlucci1 · Beatrice Damasio3 · Giorgio Piaggio4 · Ludovica Degl’Innocenti4 · Girolamo Mattioli1,2 Received: 2 September 2019 / Revised: 28 March 2020 / Accepted: 6 April 2020 © Springer Nature Singapore Pte Ltd 2020
Abstract Purpose Uretero-pelvic junction obstruction is the most common cause of prenatal hydronephrosis. It can be intrinsic, extrinsic due to crossing vessel (CV) or mixed. This paper aims to present the surgical outcome in a single pediatric thirdlevel center. Methods A retrospective analysis of all children operated between 2011 and 2018 was conducted. Demographic information, pre-operative pelvic antero-posterior diameter (APD), intra-operative parameters, hospital stay and follow-up were considered. Re-do operations and success rate for Vascular Hitch (VH), open and laparoscopic pyeloplasties were recorded. Results 128 patients were included. The mean pre-operative APD was 30 mm. The etiology was intrinsic in 71.9%, extrinsic in 25.0% and mixed in 3.1%. The median age between intrinsic and extrinsic groups was statistically different. Thirty-one VH, 88 dismembered and 9 non-dismembered pyeloplasties were performed. The median hospital stay was 2 days for VH and 6 for pyeloplasties. The median hospital stay was statistically longer in open pyeloplasties compared to laparoscopic. The mean post-operative APD was 14 mm. The success rate after VH was 90.3%, after open pyeloplasties 97.9% and after mini-invasive pyeloplasties 91.8%. Conclusions VH could be a good option in the treatment of hydronephrosis due to CV, laparoscopic pyeloplasties have equivalent success rate and shorter hospital stay than open pyeloplasties. Keywords Uretero-pelvic junction obstruction · Crossing vessels · Hydronephrosis · Vascular hitch · Pyeloplasty Abbreviations UPJO Ureteropelvic junction obstruction UPJ Ureteropelvic junction CV Crossing vessel DP Dismembered pyeloplasty NDP Non dismembered pyeloplasty APD Antero-posterior diameter
* Michela Cing Yu Wong [email protected] 1
Pediatric Surgery Department, Pediatric Surgery Unit, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy
2
DINOGMI, University of Genoa, Genoa, Italy
3
Radiology Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy
4
Nephrology, Dialysis and Renal Transplantation Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genoa, Italy
US Ultrasound fMRU Functional magnetic resonance urography
Introduction Hydronephrosis is the impairment of urinary flow from the renal pelvis to the ureter. Most cases are caused by intrinsic factors, such as an aperistaltic ureteral segment, infoldings of the ureteral wall or true strictures [1]. Extrinsic forms of uretero-pelvic junction obstruction (UPJO) include the presence of an aberrant crossing vessel (C
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