Introduction and Objectives
Pelviureteral obstruction in childhood is the consequence of congenital stenosis or a crossing vessel to the lower renal pole. In a retrospective analysis of children operated at our department, we evaluated the frequency and treatment modalities of these two disorders in various age groups, as well as the late outcome of the interventions.
Material and Methods
A total of 120 operations were performed on 114 children (6 children underwent bilateral operations) between the 1st of January 2000 and the 31st of May 2006. The cause of obstruction was congenital pyeloureteral stenosis in 75, a crossing vessel in 45 cases. Patients were divided into three age groups (I: <1 year, II: 1–5 years, III: >5 years). Long term follow-up (more than 3 years) including abdominal ultrasonography, intravenous urography and radioisotopic examinations was performed.
Results
The incidence of crossing vessel increased with age (Group I: 12%, Group II 43% Group III 53%). An Anderson-Hynes pyeloplasty was performed in 105 cases. Transection, transposition or hitch of the crossing vessel without pyeloplasty was sufficient in 7. Nephrectomy was done in eight children. Improvement in hydronephrosis and drainage occurred in 105 kidneys out of 112 (93.8%). Secondary nephrectomy or reoperation was required in 1 case, each. Transection of the lower pole artery did not result in significant loss of parenchyma according to follow-up investigations.
Conclusions
Neonatally or postnatally diagnosed hydronephrosis is caused by pyeloureteral stenosis in the majority of cases. Therefore, a negative ultrasonography of the infant does not preclude the possibility of a childhood hydronephrosis due to crossing vessels. In older children more than 50% of all hydronephrosis are caused by crossing vessels. This should be considered when the surgical plan is devised. In our opinion, vascular surgery without pyeloplasty is appropriate only in selected cases. Crossing vessels often lead to so-called “intermittent hydronephrosis”, therefore in case of recurrent pain control abdominal ultrasonography is required when symptoms appear.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
