Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 11, November, p. 1507–1511

doi: 10.17219/acem/104528

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Detection rate of crossing vessels in pediatric hydronephrosis: Transperitoneal laparoscopy versus open lumbotomy

Marcin Polok1,A,B,C,D, Dominika Borselle1,B,C, Krystian Toczewski1,B,C, Wojciech Apoznański1,E,F, Dariusz Patkowski1,C,E,F

1 Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland


Background. A bundle of crossing vessels (CV) supplying the lower pole of the kidney and causing mechanical obstruction of the ureteropelvic junction (UPJ) has been the subject of many discussions. During pyeloplasty, it is possible to overlook the CV. This may result in recurrent dilatation of the kidney and the need for re-surgery.
Objectives. To compare the detection rate of CV in UPJ obstruction (UPJO) depending on the operational access applied (transperitoneal laparoscopy (LAP) vs open lumbotomy (OPEN)). Assessment of features that could indicate the presence of CV.
Material and Methods. Two hundred and forty-six pediatric pyeloplasties were performed between January 2006 and July 2017 in the Department of Pediatric Surgery and Urology at the Wroclaw Medical University, Poland – 111 out of them by LAP and 135 by OPEN, on 98 girls and 148 boys. A retrospective analysis of the patient records for the detection of CV and characteristics of the CV before surgery was performed.
Results. Intraoperative CV causing obstruction of the UPJ in the LAP group were recognized in 34.2% (n = 38) of the patients, and within the OPEN group in 12.5% (n = 17) (p < 0.0001); 90% (n = 27) of patients with the diagnosed CV did not show congenital hydronephrosis. In 68% (n = 21) of the patients there were cases of recurrent renal colic. The presence of CV was suspected in 7.2% of kidney ultrasounds and in 12.5% in computed tomography (CT) urograms.
Conclusion. The detection rate of CV in UPJO is statistically higher in LAP access than in open retroperitoneal lumbotomy. The distinguishing features of patients with CV are the lack of prenatal diagnosis for hydronephrosis and the presence of pain in the lumbar region.

Key words

hydronephrosis, ureteropelvic junction obstruction, pyeloplasty, vascular hitch, crossing vessels

References (18)

  1. Hacker HW, Szavay P, Dittmann H, Haber HP, Fuchs J. Pyeloplasty in children: Is there a difference in patients with or without crossing lower pole vessel? Pediatr Surg Int. 2009;25(7):607–611.
  2. Kolęda P, Apoznański W, Woźniak Z, et al. Changes in interstitial cell of Cajal-like cells density in congenital ureteropelvic junction obstruction. Int Urol Nephrol. 2012;44(1):7–12.
  3. Szydełko T, Apoznański W, Kolęda P, Rusiecki L, Janczak D. Laparoscopic pyeloplasty with cephalad translocation of the crossing vessel – a new approach to the Hellström technique. Wideochir Inne Tech Maloinwazyjne. 2015;10(1):25–29.
  4. Wolak P, Golabek T, Obarzanowski M. A complex case of abdominal pain in a patient with pelviureteric junction obstruction. Wideochir Inne Tech Maloinwazyjne. 2014;9(2):273–275.
  5. Stephens FD. Ureterovascular hydronephrosis and the aberrant renal vessel. J Urol. 1982;128(5):984–987.
  6. Polok M, Apoznański W. Anderson-Hynes pyeloplasty in children – long-term outcomes, how long follow up is necessary? Cent European J Urol. 2017;70(4):434–438.
  7. Menon P, Rao KL, Sodhi KS, Bhattacharya A, Saxena AK, Mittal BR. Hydronephrosis: Comparison of extrinsic vessel versus intrinsic ureteropelvic junction obstruction groups and a plea against the vascular hitch procedure. J Pediatr Urol. 2015;11(2):80.e1–6.
  8. Weiss DA, Kadakia S, Kurzweil R, Srinivasan AK, Darge K, Shukla AR. Detection of crossing vessels in pediatric ureteropelvic junction obstruction: Clinical patterns and imaging findings. J Pediatr Urol. 2015;11(4):173.e1–5.
  9. Veyrac C, Baud C, Lopez C, Couture A, Saguintaah M, Averous M. The value of colour Doppler ultrasonography for identification of crossing vessels in children with pelviureteric junction obstruction. Pediatr Radiol. 2003;33(11):745–751.
  10. Van Cangh PJ, Wilmart JF, Opsomer RJ, Abi-Aad A, Wese FX, Lorge F. Long-term results and late recurrence after endoureteropyelotomy: A critical analysis of prognostic factors. J Urol. 1994;151(4):934–937.
  11. Nakada SY, Wolf JS, Brink JA, et al. Retrospective analysis of the effect of crossing vessels on successful retrograde endopyelotomy outcomes using spiral computerized tomography angiography. J Urol. 1998;159(1):62–65.
  12. Sampaio FJ. Vascular anatomy at the ureteropelvic junction. Urol Clin North Am. 1998;25(2):251–258.
  13. Zeltser IS, Liu JB, Bagley DH. The incidence of crossing vessels in patients with normal ureteropelvic junction examined with endoluminal ultrasound. J Urol. 2004;172(6 Pt 1):2304–2307.
  14. Calisti A, Perrotta ML, Oriolo L, Patti G, Marrocco G, Miele V. Functional outcome after pyeloplasty in children: Impact of the cause of obstruction and of the mode of presentation. Eur Urol. 2003;43(6):706–710.
  15. Schneider A, Ferreira CG, Delay C, Lacreuse I, Moog R, Becmeur F. Lower pole vessels in children with pelviureteric junction obstruction: Laparoscopic vascular hitch or dismembered pyeloplasty? J Pediatr Urol. 2013;9(4):419–423.
  16. Maheshwari R, Ansari MA, Mandhani A, Srivastava A, Kapoor R. Laparoscopic pyeloplasty in pediatric patients: The SGPGI experience. Indian J Urol. 2010;26(1):36–40.
  17. Assem A, Hashad MM, Badawy H. Retroperitonoscopic pyelopexy for pelviureteral junction obstruction with crossing vessel in adolescents: Hellström principle revisited. J Pediatr Urol. 2013;9(4):415–418.
  18. Simforoosh N, Javaherforooshzadeh A, Aminsharifi A, Soltani MH, Radfar MH, Kilani H. Laparoscopic management of ureteropelvic junction obstruction in pediatric patients: A new approach to crossing vessels, crossing vein division, and upward transposition of the crossing artery. J Pediatr Urol. 2010;6(2):161–165.