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Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?

Objectives: Assessment of the efficacy of intraoperative diagnosis between extrinsic and intrinsic UPJO in children. Assessment of the efficacy of laparoscopic vascular-hitch procedure in UPJO caused by lower pole crossing vessels (CV). Materials and Methods: Between 2008 and 2017, 47 laparoscopic p...

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Autores principales: Polok, Marcin, Toczewski, Krystian, Borselle, Dominika, Apoznański, Wojciech, Jędrzejuk, Diana, Patkowski, Dariusz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433871/
https://www.ncbi.nlm.nih.gov/pubmed/30941339
http://dx.doi.org/10.3389/fped.2019.00083
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author Polok, Marcin
Toczewski, Krystian
Borselle, Dominika
Apoznański, Wojciech
Jędrzejuk, Diana
Patkowski, Dariusz
author_facet Polok, Marcin
Toczewski, Krystian
Borselle, Dominika
Apoznański, Wojciech
Jędrzejuk, Diana
Patkowski, Dariusz
author_sort Polok, Marcin
collection PubMed
description Objectives: Assessment of the efficacy of intraoperative diagnosis between extrinsic and intrinsic UPJO in children. Assessment of the efficacy of laparoscopic vascular-hitch procedure in UPJO caused by lower pole crossing vessels (CV). Materials and Methods: Between 2008 and 2017, 47 laparoscopic procedures were performed with the CV discovered intraoperatively. CV were translocated cephalad, and the UPJ was carefully inspected. The Chapman's vascular hitch procedure was accomplished in the case of decreasing sizes of the pelvis and clear, visible peristalsis of the UPJ (31 patients). In the other cases, Anderson–Hynes (A-H) pyeloplasty with posterior translocation of the CV was performed (16 patients). Results: The median age at operation was 6 years (range 1–16) in VH and 6 years (range 2–17) in A-H (p = 0.4635). Prenatal dilatation of kidney was diagnosed in 18.7% of VH and 10% of A-H cases (p = 0.5474). Success was achieved in 16 (100%) patients in the A-H and in 29 (93.54%) in the VH groups. Two patients (6.5%) in VH required repeated surgery because of a misdiagnosed intrinsic obstruction. Median operation time in VH was 80 min (range 40–105) and was 105 (range 70–225) in A-H (p < 0.05). Conclusions: The intraoperative selection based on intraoperative pelvis and UPJ appearance after vessel transposition is sufficient in majority of cases. Laparoscopic vascular hitch seems to be effective and safe procedure, but can only be performed on carefully selected patients. In case of misdiagnosis, reoperation is possible with the same laparoscopic access.
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spelling pubmed-64338712019-04-02 Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment? Polok, Marcin Toczewski, Krystian Borselle, Dominika Apoznański, Wojciech Jędrzejuk, Diana Patkowski, Dariusz Front Pediatr Pediatrics Objectives: Assessment of the efficacy of intraoperative diagnosis between extrinsic and intrinsic UPJO in children. Assessment of the efficacy of laparoscopic vascular-hitch procedure in UPJO caused by lower pole crossing vessels (CV). Materials and Methods: Between 2008 and 2017, 47 laparoscopic procedures were performed with the CV discovered intraoperatively. CV were translocated cephalad, and the UPJ was carefully inspected. The Chapman's vascular hitch procedure was accomplished in the case of decreasing sizes of the pelvis and clear, visible peristalsis of the UPJ (31 patients). In the other cases, Anderson–Hynes (A-H) pyeloplasty with posterior translocation of the CV was performed (16 patients). Results: The median age at operation was 6 years (range 1–16) in VH and 6 years (range 2–17) in A-H (p = 0.4635). Prenatal dilatation of kidney was diagnosed in 18.7% of VH and 10% of A-H cases (p = 0.5474). Success was achieved in 16 (100%) patients in the A-H and in 29 (93.54%) in the VH groups. Two patients (6.5%) in VH required repeated surgery because of a misdiagnosed intrinsic obstruction. Median operation time in VH was 80 min (range 40–105) and was 105 (range 70–225) in A-H (p < 0.05). Conclusions: The intraoperative selection based on intraoperative pelvis and UPJ appearance after vessel transposition is sufficient in majority of cases. Laparoscopic vascular hitch seems to be effective and safe procedure, but can only be performed on carefully selected patients. In case of misdiagnosis, reoperation is possible with the same laparoscopic access. Frontiers Media S.A. 2019-03-19 /pmc/articles/PMC6433871/ /pubmed/30941339 http://dx.doi.org/10.3389/fped.2019.00083 Text en Copyright © 2019 Polok, Toczewski, Borselle, Apoznański, Jędrzejuk and Patkowski. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Polok, Marcin
Toczewski, Krystian
Borselle, Dominika
Apoznański, Wojciech
Jędrzejuk, Diana
Patkowski, Dariusz
Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?
title Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?
title_full Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?
title_fullStr Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?
title_full_unstemmed Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?
title_short Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?
title_sort hydronephrosis in children caused by lower pole crossing vessels—how to choose the proper method of treatment?
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433871/
https://www.ncbi.nlm.nih.gov/pubmed/30941339
http://dx.doi.org/10.3389/fped.2019.00083
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