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(PP)
LAPAROSCOPIC TRANSPOSITION OF LOWER-POLE CROSSING VESSELS : A LONG
TERM FOLLOW-UP OF 33 PATIENTS AT PUBERTY
Sébastien FARAJ
1
, François-Xavier MADEC
1
, Thierry VILLEMAGNE
1
, Michel BARON
2
, Laurent FOURCADE
3
, Hubert LARDY
1
and Marc-David LECLAIR
4
1) Children University Hospital, Pediatric Surgery, Nantes, FRANCE - 2) Centre Hospitalier de St Nazaire, Urology, Saint
Nazaire, FRANCE - 3) University Hospital, Pediatric Surgery, Limoges, FRANCE - 4) Hôpital Mère-Enfant, Chirurgie
Infantile, Nantes, FRANCE
PURPOSE
Laparoscopic transposition of lower-pole crossing vessels (LPCV) has been described as an effective alternative to
dismembered pyeloplasty in selected indications of hydronephrosis, with purely extrinsic vascular PUJ obstruction.
We report on the long term follow-up of children, treated with this technique during childhood, reviewed after they had
reached puberty, focusing on the incidence of recurrent symptoms, residual renal dilatation, and systemic hypertension.
PATIENTS AND METHODS
Early 2015, we performed systematic clinical and radiological assessment of 33 adolescent patients (16 years [12-
22]), who had undergone laparoscopic transposition of LPCV during childhood.
Assessment was based on :
- Clinical examination focusing on frequency of episodes of loin pain or UTIs
- Arterial blood pressure (ABP) measurements, compared to norms adjusted to height and age
- Renal ultrasonography (SFU grade) in 21/33 patients
RESULTS
The median follow-up after surgery was 69 months [13-113].
- Renal US showed residual SFU grade 2 pelvicalyceal dilatation in 2 asymptomatic patients (10%), SFU grade 1
extrarenal pelvis dilatation in 3, and was normal in the remaining.
- ABP was within normal range in all patients, adjusted for age and height.
- Three patients had occasional episodes of abdominal pain : two of them had normal US (including during pain
episodes), one had persistent extrarenal dilated pelvis (31mm,vs>60mm preoperatively) with no calyceal dilatation.
None of them showed obvious clinical characteristics linking the pain to a renal origin.
- One adolescent presented with febrile UTI at 18 years (8 years postoperatively) with normal renal US, and no
hypertension.
CONCLUSIONS
In the long term follow-up, the vast majority of adolescents treated during childhood by laparoscopic transposition of
LCPV for PUJ extrinsic obstruction remain asymptomatic, with normal arterial blood pressure, and normal renal
ultrasound when they reach puberty.