Laparoscopic pyeloplasty in children with ureteropelvic junction obstruction associated with crossing renal vessels

Introduction: Ureteropelvic junction obstruction (UPJO) is usually intrinsic; however, 15%–52% may be associated with crossing renal/lower pole vessels. Investigators have demonstrated that the presence of crossing vessels decreased the success rate of antegrade endopyelotomy. We prospectively reviewed our series of laparoscopic pyeloplasty in children and analyzed as to whether crossing vessels affected the morbidity and outcome. Methods: Children <18 years of age undergoing laparoscopic pyeloplasty for UPJO were prospectively included in the study. Pyeloplasty was performed anterior to the vessels, and the anastomosis was placed adequately distal to the crossing vessel. Children were followed up in the postoperative period for urinary tract infection, and a DTPA renogram was performed after 3 months in all. Results: Twenty (15.74%) children had crossing renal/lower pole vessels associated with UPJO. The mean age of these children was 11.0 ± years. The mean operating time was 96.15 ± 12.54 min as compared to 76.35 ± 8.16 min in children with UPJO alone. The mean blood loss was 31.50 ± 6.03 cc as compared to 29.56 ± 4.50 cc in children with UPJO alone. The mean postoperative hospital stay 51.50 h and 100% of the children showed improvement of renal function as well as drainage on the postoperative diuretic renogram done after 12 weeks of surgery. Conclusions: Crossing renal/lower polar is associated with UPJO in about 15% of children undergoing laparoscopic pyeloplasty. The presence of crossing vessels significantly prolonged operating time; however, the blood loss, postoperative hospital stay, and short-term outcomes were similar to children with UPJO alone