Individualized Laparoscopic Surgery for UPJO Patients with Crossing Vessels

Background: To characterize the anatomical subtypes of ureteropelvic junction obstruction (UPJO) caused by crossing vessels (CVs) and demonstrate the Individualized operation procedures for these cases. Methods: From March 2015 to July 2019, 51 consecutive adult patients underwent treatment of primary UPJO via a retroperitoneal laparoscopic approach. The clinical data, iconography inspection results, and surgical procedures for each patient were retrospectively reviewed by our team. The diagnosis of etiological CV was confirmed during the operation in 13 patients (25.49%), which included 7 men and 6 women. Results: : The mean surgical age was 30±11.66 years. The operating time was approximately 233±62.76 minutes, and there were one open conversions. In the follow-up period (mean, 27.23±15.46 months), all patients had a full recovery in the CV group. However, 3 patients without CV did not completely recover from uronephrosis, as determined on iconography inspection, and there was no improvement in the renal colic symptoms. In the CV group, none of the patients had lithiasis whereas 25% of the patients without CV had lithiasis. Conclusion: CV accounts for approximately 25.49% of the UPJO cases. Based on the anatomical position of the UPJ and CVs, we identified two types of abnormalities, and 84.62% of the CVs were located anterior to the UPJ. The retroperitoneal approach for treating CVs had particular advantages. A comprehensive understanding and interoperative analysis of the anastomosis between the CVs and UPJ is crucial for at least 4 individual treatments. After dismembered pyeloplasty, suspension of the CVs is recommended in approximately 40% of the cases. The follow-up showed good prognosis in the long term.