LAPAROSCOPIC DIVISION OF CROSSING VESSELS AT THE URETEROPELVIC JUNCTION

Endopyelotomy has become an accepted mode of treatment for primary and secondary ureteropelvic junction (UPJ) obstruction, but a 15% to 30% failure rate persists, The presence of crossing vessels at the UPJ has been implicated as a common cause of complications, failures, and rec urrences, In the past, renal angiography was necessary to identify cro ssing vessels, We have utilized endoluminal ultrasonography to identif y crossing vessels at the UPJ and to guide endoscopic incisional techn iques, Previously, whenever crossing vessels were identified that coul d not be safely avoided during endopyelotomy, we had recommended disme mbered pyeloplasty, an open surgical procedure with a long recovery ti me, We report our experience with laparoscopic division of crossing ve ssels in two patients, one with a symptomatic horseshoe kidney, Each p atient had a large crossing vessel identified by endoluminal ultrasono graphy; consequently, endopyelotomy was abandoned, The location and di stribution of the vessels were then delineated by angiography, The abe rrant vessels were dissected free and divided laparoscopically, The pa tients returned to work within 1 week, Follow-up diuretic renal scans showed complete resolution of obstruction (T-1/2 < 10 minutes) in one patient; no change was noted in the patient with a horseshoe kidney, B oth patients have remained free of symptoms and normotensive for more than 12 months, Laparoscopic division of crossing vessels may play a r ole in the treatment of patients with extrinsic ureteral obstruction f rom aberrant vessels.