Uretero-pelvic junction obstruction in children: Is vascular hitch an effective and safe solutions in very long term outcome? Report of 25 years follow-up


Submitted: 28 January 2023
Accepted: 2 February 2023
Published: 22 February 2023
Abstract Views: 2760
PDF: 300
HTML: 9
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Salvatore Fabio Chiarenza Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies San Bortolo Hospital, Vicenza, Italy.
  • Elena Carretto Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies San Bortolo Hospital, Vicenza, Italy.
  • Valeria Bucci Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies San Bortolo Hospital, Vicenza, Italy.
  • Samuele Ave Division of Nuclear Medicine, Ospedale S. Bortolo, Vicenza, Italy. https://orcid.org/0000-0003-1169-8769
  • Giuseppe Pulin Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies San Bortolo Hospital, Vicenza, Italy.
  • Cosimo Bleve Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies San Bortolo Hospital, Vicenza, Italy.

Vascular (VH) according to Hellstrom-Chapman technique is considered a safe and effective alternative approach to pure extrinsic Ureteropelvic Junction Obstruction (UPJO) with good results in short and medium term, but few data are available on long and verylong term outcomes. Our aim is to evaluate VH long and very-long term outcomes in patients treated in pediatric age focusing on relapse, development of hypertension and/or inferior polar kidney hypotrophy during puberty and adulthood. From 1990 to 2015 in our Department 76 children were treated by open or laparoscopic VH for pure extrinsic-UPJO. We were able to contact 54 of 76. 41 patients (25 males, 16 females) accepted to be studied. Mean follow- up time was 12.7 years (range 6-27 years); mean age at the assessment was 22.2 years. We excluded patients who were younger than 13 (if females) or 14 (if males) at the assessment (upper limits of physiological puberty onset). Patients were followed with US, MAG-3-scan and arterial blood pressure measurement. Collected data were compared with the preoperative ones by Student t-test. 95% of US images and MAG-3-scan reports were compatible with complete resolution of obstruction with good renal functionality. 87% of patients were completely healthy. We recorded 3 cases of hypertension (7%) not secondary to renovascular origin; 2 cases with recurrent flank pain (5%) with slightly dilated pelvis at the US and sub-obstructive pattern at MAG-3-scan with preserved renal function. Our experience confirms that VH, (open/laparoscopic) is a safe and effective procedure with good outcomes at very longterm follow-up. No patients at puberty and in adulthood required reoperation or presented polar hypotrophy and related vascular hypertension. VH is an alternative approach to pure extrinsic-UPJO. There were few data about long and very-long term outcomes in patients after this kind of surgery. We followed-up 41 patients confirming that VH (open/laparoscopic) is safe and effective with good long-term outcomes.


Anderson JC, Hynes W. Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol 1949;21:209–14. DOI: https://doi.org/10.1111/j.1464-410X.1949.tb10773.x

Hellström J, Giertz G, Lindblom K. Pathogenesis and treatment of hydronephrosis. In: Presented at VIII Congreso de la Sociedad International de Urologia, Paris, France; 1949.

Chapman TL. Urology in outline. Edinburgh, London: Churchill Livingstone; 1959. p. 82

Esposito C, Bleve C, Escolino M, et al. Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction. Transl Pediatr 2016;5:256–61. DOI: https://doi.org/10.21037/tp.2016.09.08

Chiarenza SF, Bleve C, Fasoli L, et al. Ureteropelvic junction obstruction in children by polar vessels. Is laparoscopic vascular hitching procedure a good solution? Single center experience on 35 consecutive patients. J Pediatr Surg 2016;51:310–4. DOI: https://doi.org/10.1016/j.jpedsurg.2015.10.005

Pesce C, Campobasso P, Costa L, et al. Ureterovascular hydronephrosis in children: is pyeloplasty always necessary? Eur Urol 1999;36:71-4. DOI: https://doi.org/10.1159/000019930

Grattan-Smith JD, Little SB, Jones RA. MR urography evaluation of obstructive uropathy. Pediatr Radiol 2008;38:S49-69. DOI: https://doi.org/10.1007/s00247-007-0667-y

Wong MCY, Piaggio G, Damasio MB, et al. Hydronephrosis and crossing vessels in children: Optimization of diagnostict herapeutic pathway and analysis of color Doppler ultrasound and magnetic resonance urography diagnostic accuracy. J Pediatr Urol 2018;14:68.e1-68.e6. DOI: https://doi.org/10.1016/j.jpurol.2017.09.019

Hammer MR, Kraft KH, Ivančić V, et al. Pediatric ureteropelvic junction obstruction: can magnetic resonance urography identify crossing vessels? Pediatr Radiol 2015;45:1788-95. DOI: https://doi.org/10.1007/s00247-015-3412-y

Madec FX, Faraj S, Villemagne T, et al. Laparoscopic transposition of lower-pole crossing vessels: Long-term follow-up of 33 patients at puberty. J Pediatr Urol. 2016 Aug;12(4):226.e1-6. DOI: https://doi.org/10.1016/j.jpurol.2016.03.016

Villemagne T, Fourcade L, Camby C, et al. Longterm results with the laparoscopic transposition of renal lower pole crossing vessels. J Pediatr Urol 2015;11:174.e1-7. DOI: https://doi.org/10.1016/j.jpurol.2015.04.023

Szavay P, Heyne-Pietschmann M, Zundel SM. Subpelvine Stenose/Kreuzendes Gefas – kontra vascular hitch [Uretero-pelvic junction obstruction due to crossing pole vessel: contra vascular hitch]. Aktuelle Urol 2020;51:121-126. DOI: https://doi.org/10.1055/a-1097-4809

Schneider A, Gomes Ferreira C, Delay C, et al. Lower pole vessels in children with pelviureteric junction obstruction: laparoscopic vascular hitch or dismembered pyeloplasty? J Pediatr Urol 2013;9:419–23. DOI: https://doi.org/10.1016/j.jpurol.2012.07.005

Meng MV, Stoller ML. Hellström technique revisited: laparoscopic management of ureteropelvic junction obstruction. Urology 2003;62:404-8; discussion 408-9. DOI: https://doi.org/10.1016/S0090-4295(03)00562-4

Masood J, Panah A, Zaman F, et al. Laparoscopic cranial plication in pelviureteral junction obstruction by aberrant lower pole artery. J Endourol 2009;23:7-10. DOI: https://doi.org/10.1089/end.2008.0284

Abbo O, Patard PM, Mouttalib S, et al. Transposition des vaisseaux polaires pour syndrome de la jonction pyélo-urétérale : expérience préliminaire. Progrès en Urologie 2015;25:96–100. DOI: https://doi.org/10.1016/j.purol.2014.11.010

Barrat T, Avner E, Harmon B, editors. Pediatric nephrology. 4th ed. Baltimore: Lippincott Williams & Wilkins; 1999. p. 1368e70.

Shankar RR, Eckert GJ, Saha C, et al. The change in blood pressure during pubertal growth. J Clin Endocrinol Metab 2005;90:163e7. DOI: https://doi.org/10.1210/jc.2004-0926

Chiarenza, S. F., Carretto, E., Bucci, V., Ave, S., Pulin, G., & Bleve, C. (2023). Uretero-pelvic junction obstruction in children: Is vascular hitch an effective and safe solutions in very long term outcome? Report of 25 years follow-up. La Pediatria Medica E Chirurgica, 45(1). https://doi.org/10.4081/pmc.2023.309

Downloads

Download data is not yet available.

Citations