Pelvi-Ureteric Junction Obstruction With Crossing Renal Vessels: A Case Report Of Failed Laparoscopic Vascular Hitch

Main Category: Urology / Nephrology
Article Date: 30 Apr 2009 - 3:00 PDT

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UroToday.com - Ureteropelvic junction obstruction (UPJO) secondary to crossing vessels is typically approached with a dismembered pyeloplasty, which may be open, laparoscopic or robotically assisted.

In 2003, Hellstrom first described the open technique of relocation of the lower pole vessel causing UPJO. In 2006, a laparoscopic approach was described by Duncan Wilcox and his colleagues. This study by Dr. Rajenda Nerli et al. described a case report of their laparoscopic vascular hitch that failed. There could be several factors responsible for this outcome including a missed concurrent intrinsic factor; fibrosis; suture breakdown; and kinking of the UPJ after pelvic hitching.

In my opinion, we should learn from our past. The Hellstrom Procedure does not carry the same success rate as for open dismembered pyeloplasty. We do nothing different laparoscopically. All laparoscopic surgery must recapitulate open techniques or else it has been my experience the results will not be as favorable. When we deviate in surgical principles, our patients suffer. We do need to evolve, but certain basic concepts cannot be refuted. When we start taking shortcuts in MIS, we ALL lose.

Nerli RB, Jayanthi VR, Reddy M, Koura A
J Pediatr Urol. 2009 Apr;5(2):147-50
10.1016/j.jpurol.2008.09.009

Written by UroToday.com Medical Editor Pasquale Casale, MD

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