Ureterovascular hydronephrosis in children: Is pyeloplasty always necessary?

Objective: To evaluate the efficacy of the vessel transposition technique i n ureterovascular hydronephrosis in children. Methods: Over a 25-year perio d, we treated 111 patients with 112 instances of ureterovascular hydronephr osis. In order to determine the obstructive effect of the vessels, we perfo rmed an intraoperative diuretic test. Using this approach, 61 patients judg ed to have only vascular pyeloureteral junction obstruction underwent vesse l transposition. However, 50 patients in whom the intraoperative diuretic t est proved doubtful needed pyeloplasty, Results: Surgical success was achie ved in 98% of the patients. Only 1 child treated by vessel transposition ha d an unsatisfactory outcome which necessitated a subsequent pyeloplasty for persistent hydronephrosis. This was due to a previously unrecognized intri nsic pyeloureteral junction obstruction. Conclusion: Based on our clinical experience, the intraoperative diuretic test has proven to be a safe and ef fective diagnostic tool in children with ureterovascular hydronephrosis. It s use may contribute to treating so me cases of ureterovascular hydronephro sis without resorting to pyeloplasty.