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Ureteropelvic Junction Obstruction Caused by Crossing Vessels in Infants and Young Children
Dongyan Zhao1, Long Sun1, Chang Tao1
1Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310000, China.
Insights
Crossing vessels (CV) causing ureteropelvic junction obstruction (UPJO) are common in infants and young children. Laparoscopic pyeloplasty (LP) is recommended as open pyeloplasty (OP) may miss these critical vascular anomalies.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Vascular Anatomy
Background:
- Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly in children.
- Crossing vessels (CV) are a frequent cause of UPJO, particularly in younger patients.
- Accurate diagnosis and surgical management are crucial for preserving renal function.
Purpose of the Study:
- To analyze the clinical characteristics of UPJO caused by CV in infants and young children.
- To compare the detection rates of CV in laparoscopic pyeloplasty (LP) versus open pyeloplasty (OP).
- To evaluate the impact of age on CV presentation and surgical outcomes.
Main Methods:
- Retrospective analysis of 747 children with UPJO who underwent primary surgery.
- Classification into laparoscopic pyeloplasty (LP) and open pyeloplasty (OP) groups.
- Stratification by age (≤3 years vs. >3 years) and identification of CV-caused UPJO cases.
Main Results:
- Ninety cases of CV-associated UPJO were identified.
- CV discovery rate was significantly higher in the LP group (17.1%) compared to the OP group (4.1%) (P < 0.001).
- No significant difference in CV discovery rates was observed between age groups (≤3 vs. >3 years) within the LP group. Preoperative confirmation of CV was absent in the ≤3 group.
Conclusions:
- Crossing vessels are not rare in infants and young children with UPJO and occur across all age groups.
- Laparoscopic pyeloplasty is recommended due to a higher likelihood of detecting CV compared to open pyeloplasty.
- Failure to detect CV during open pyeloplasty can lead to reoperation.
Background:
To analyze the clinical characteristics of ureteropelvic junction obstruction (UPJO) caused by crossing vessels (CV) in infants and young children.
Methods:
A retrospective analysis was performed on children with UPJO who underwent primary surgery. Patients were classified into laparoscopic pyeloplasty (LP) and open pyeloplasty (OP) groups and classified as ≤3 or >3 (years old) groups. Children with CV-caused UPJO were identified.
Results:
A total of 747 patients were included. Ninety cases of CV were identified. The CV discovery rate was higher in the LP group (78/457, 17.1%) than in the OP group (12/290, 4.1%) (P < 0.001). In the ≤3 group, the CV discovery rate in the LP group (27/144, 18.8%) was higher than that in the OP group (11/274, 4.0%) (P < 0.001). In the LP group, there was no significant difference between ≤3 (27/144, 18.8%) and >3 (51/313, 16.3%) groups in the CV discovery rate. The rate in children with UPJO was not significantly different at any age (P > 0.05). Progressive aggravation of hydronephrosis (21/27, 77.8%) and symptomatic hydronephrosis (44/51, 86.3%) were the main surgical indications in the ≤3 and > 3 groups, respectively. There were no preoperatively confirmed cases of CV in the ≤3 group. In the OP group, five patients underwent reoperation, three of whom were due to failure to detect CV during the initial operation.
Conclusions:
The CV distribution is similar in children with UPJO across all ages; CV in infants and young children are not rare. LP should be considered as CV are prone to being missed during OP.
Levels Of Evidence:
III.
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