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.
|Number of pages||5|
|Journal||Nishinihon Journal of Urology|
|Publication status||Published - Apr 1 1999|
- Helical computed tomography
- Ureteropelvic junction obstruction
ASJC Scopus subject areas