Retroperitoneoscopic pyelotomy combined with transposition of crossing vessels for ureteropelvic junction obstruction

Atsushi Nagai, Hideaki Hashimoto, Masaya Tsugawa, Yasutomo Nasu, Hiromi Kumon

    Research output: Contribution to journalArticlepeer-review

    Abstract

    We have developed a new approach comprising retroperitoneoscopic pyelotomy combined with transposition of crossing vessels for ureteropelvic junction obstruction. From February 1997 to March 1998, we identified 6 cases of ureteropelvic junction obstruction due to crossing vessels by helical computed tomography. 'Ureterovascular hydronephrosis' characterized by malrotated renal pelvis with anterior crossing vessels was observed in 4, while ureteropelvic junction obstruction with posterior crossing vessels was observed in 2. Two female and 4 male patients, ranging from 9 to 60 years of age underwent retroperitoneoscopic surgery. After insertion of an endoureterotomy stent cystoscopically, retroperitoneoscopic surgery was carried out in the standard kidney position. Crossing vessels were found after removal of the periureteral adipose tissue and were freed from the ureter. After complete detachment, the vessels were transposed to a higher position in the renal pelvis and fixed with absorbable clips using peripelvic tissue. The resulting ureteropelvic junction was incised longitudinally for about 1.5 cm with a potassium titanyl phosphate (KTP) laser in 4 cases, although this incision was omitted in 2 cases where ureteropelvic junction obstruction appeared perfectly normal. The postoperative course was uneventful in all cases and the stent was removed 4-8 weeks postoperatively. Postoperative excretory urography (IVP) showed significant resolution of the hydronephrosis in 5 patients, but no significant resolution in 1 patient, who had not received the pyelotomy. This procedure is a simple but reliable method for ureterovascular hydronephrosis and related conditions as a minimally invasive alternative to conventional antegrade or retrograde endopyelotomy.

    Original languageEnglish
    Pages (from-to)308-312
    Number of pages5
    JournalNishinihon Journal of Urology
    Volume61
    Issue number4
    Publication statusPublished - Apr 1 1999

    Keywords

    • Helical computed tomography
    • Hydronephrosis
    • Retroperitoneoscopy
    • Ureteropelvic junction obstruction

    ASJC Scopus subject areas

    • Urology

    Fingerprint

    Dive into the research topics of 'Retroperitoneoscopic pyelotomy combined with transposition of crossing vessels for ureteropelvic junction obstruction'. Together they form a unique fingerprint.

    Cite this