Abstract
Objectives
To present our experience with the treatment of adult ureteropelvic junction (UPJ)
obstruction using a laparoscopic Hellström vascular relocation technique.
Methods
Transperitoneal laparoscopy was performed in 35 patients for the management of UPJ
obstruction. In 9 cases, we identified crossing lower pole vessels and performed the
Hellström technique. We discuss our indications, intraoperative techniques, and outcomes
when performing only vascular relocation in these patients.
Results
All 9 patients presented with long-standing flank pain and were identified as having
UPJ obstruction (7 primary, 2 secondary) on radiographic imaging. The intraoperative
decision to perform the Hellström technique was based on the presence of the crossing
vessels, a grossly normal appearance of the ureter and UPJ, and a small renal pelvis.
The crossing vessels were completely mobilized, displaced cephalad, and fixed using
intracorporeal sutures. The mean operative time and blood loss was 164 minutes and
15 mL, respectively. At a mean follow-up of 19 months (range 14 to 31), the patients
were asymptomatic with no evidence of obstruction on Lasix nuclear renography.
Conclusions
Traditional treatment of UPJ obstruction, with or without crossing vessels, has been
accomplished by pyeloplasty. Dismembered pyeloplasty is a standard method in cases
of associated crossing vessels; however, we propose that the Hellström technique be
considered in cases in which the ureter appears normal and the pelvic anatomy is unfavorable
for transection and anterior reanastomosis of the ureter and pelvis. These considerations
are particularly relevant during the laparoscopic approach in which intracorporeal
suturing and knot tying are technically challenging.
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Article info
Publication history
Accepted:
April 11,
2003
Received:
February 19,
2003
Identification
Copyright
© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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