Laparoscopic pyeloplasty with cephalad translocation of the crossing vessel - A new approach to the Hellström technique

Abstract

Introduction: It is believed that lower pole crossing vessels may play an important role in the etiology of ureteropelvic junction obstruction (UPJO). A conventional operative technique, which seems to be widely used in patients with UPJO, is Anderson-Hynes (A-H) plasty with dorsal transposition of the vessel. An attractive alternative to dorsal transposition of the vessel might be its cephalad translocation. Aim: To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparoscopic A-H or Y-V pyeloplasty. Material and methods: Eighty-five patients were included in the study. To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparoscopic pyeloplasty, the results of the procedure were compared to the results of laparoscopic pyeloplasties performed in patients without crossing vessels (control group). Success was defined as the following factors taken collectively: 80% or greater pain relief according to VAS, no sign of obstruction on intravenous urography (patent UPJ), decreasing excretion curve with T1/2 < 12 min, and improved or stable differential renal function on diuretic renography. Results: The mean follow-up was 53.7 months. There was no statistically significant difference in the success rate between the compared groups (group 1 - cases with cephalad translocation of the crossing artery, and group 2 - cases without crossing vessels) in patients who underwent A-H plasty or Y-V plasty. Conclusions: The analysis of our data seems to indicate that cephalad translocation of the anterior crossing vessel gives good therapeutic results in patients who undergo laparoscopic pyeloplasty.