ČESKÁ UROLOGIE / CZECH UROLOGY – 4 / 2021

234 Ces Urol 2021; 25(4): 231–235 VIDEO detected on ultrasound and Doppler imaging Diuretic scintigraphy with 99mTc-MAG3 has shown symmetrical differential renal function (48 %) and delayed drainage of the radionuclide pointing to a partial obstruction of the right kidney The right kidney was laparoscopically exposed in conventional transperitoneal way with three 5mm trocars inserted at umbilicus, above um‑ bilicus in the midline and pararectal to umbilicus The crossing vessels were released from the en‑ larged pelvis, UPJ and proximal ureter to enable free movement up and down behind the vessels („shoeshine manoeuvre “) After i v liquid infusion, the vessels were elevated from the UPJ region and 10 mg furosemide i v was administered A good passage of urine from the pelvis to the ureter across the UPJ was confirmed The vessels were wrapped into the pelvic wall well above the UPJ using two absorbable polyglactin 4/0 sutures Length of sur‑ gery 115 min Stenting was not necessary, therefore, no worry of stent syndrome and of necessity for additional anaesthesia to remove it Postoperative course was uneventful, pain settled and dilatation of the pelvicalyceal system decreased at 3- and 12- months follow-up Doppler imaging showed adequate cranial deflection of the crossing vessels and good perfusion of the kidney The laparoscopic vascular hitch was first pub‑ lished by Meng and Stoller in 2003 (6) Several articles have been published proving safety of the procedure Its success rate (97,5 % ± 1,6 %) is comparable with dismembered pyeloplasty (9) The pros are: unstented repair, shorter length of surgery and hospital stay (9, 10) Conclusions: Laparoscopic transposition of crossing vessels is a good alternative of dismem‑ bered pyeloplasty in selected patients with inter‑ mittent hydronephrosis once concomitant „intrin‑ sic“ cause of UPJ obstruction has been excluded It is a stent free procedure with a shorter operative time and shorter hospitalization KEY WORDS Hydronephrosis, ureteropelvic junction obstruc‑ tion, UPJO, vascular hitch, transposition of renal crossing vessels LITERATURA 1. Hellström J, Giertz G, Lindblom K. Pathogenesis and treatment of hydronephrosis In: Presentedat VIII Congreso de la Sociedad International de Urologia, Paris, France 1949 2. CainMP, Rink RC, Thomas AC, et al. Symptomatic ureteropelvic junction obstruction in children in the era of prenatal sonography‑is there a higher incidence of crossing vessels? Urology 2001; 57(2): 338–341 3. Menon P, Rao KLN, Sodhi KS, Bhattacharya A, et al. Hydronephrosis: Comparison of extrinsic vessel versus intrinsic ureteropelvic junction obstruction groups and a plea against the vascular hitch procedure J Pediatr Urol 2015; 11(2): 80 e1–e6 4. Zerhau P, Kubátová J, Horák D, Skotáková J, Mach V. Použití magnetické rezonance v předoperačním posouzení obstrukce močového traktu u dětí Rozhl Chir 2003; 82(2): 115–119 5. Smith JS, McGeorge A, Abel BJ, Hutchinson AG. The results of lower polar renal vessel transposition (the Chapman procedure) in the management of hydronephrosis Br J Urol 1982; 54(2): 95–97 6. Meng MV, Stoller ML. Hellström technique revisited: laparoscopic management of ureteropelvic junction obstruction Urology 2003; 62: 404–408 7. Villemagne T, Fourcade L, Camby C, et al. Long‑term results with the laparoscopic transposition of renal lower pole crossing vessels J Pediatr Urol 2015; 11(4): 174 e1–e7 8. Esposito C, Bleve C, Escolino M, et al. Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction Transl Pediatr 2016; 5(4): 256–261 9. Miscia ME, Lauriti G, Riccio A, et al. Minimally invasive vascular hitch to treat pediatric extrinsic ureteropel‑ vic junction obstruction by crossing polar vessels: a systematic review and meta‑analysis J Pediatr Urol 2021; 17(4): 493–501