Long-term nephro-urological follow-up after Hellstrom-Chapman vascular hitch: A safe and effective procedure preserving renal perfusion.

BACKGROUND

Primary cause of extrinsic ureteropelvic junction obstruction is the crossing of accessory renal pole vessels. Vascular hitch (VH) is a safe and efficient procedure. The study aimed to analyze its long-term outcomes for renal perfusion and function.

METHODS

This retrospective study included children who underwent a VH at our institute between 2006 and 2021. Further surgeries on the same kidney were an exclusion criterion. The minimum follow-up period was 2 years. Data about symptoms, blood tests, blood pressure measurement, and renal ultrasound (US) with colour Doppler was collected at long term follow-up.

RESULTS

Fifty-nine patients were included, of whom 24 consented to taking part in the study and completed all the required examinations. The median follow-up period was 8.4 years (range 2.2-15.8). Two patients (8 %) experienced recurrence of symptoms in form of urinary tract infections. Two cases (8 %) presented with hypertension, without renovascular characteristics. Blood tests showed normal renal function in all patients. Renal US showed an improvement or normalisation of the anterior-posterior pelvic diameter in all patients. Three patients (13 %) presented renal hypotrophy, already known preoperatively. Colour Doppler was normal in all patients, with median RI of 0.58 (range 0.42-0.70).

CONCLUSION

Long-term follow-up showed that VH is a feasible and safe technique for treating extrinsic ureteropelvic junction obstruction treatment in terms of preserving renal perfusion, as the cranial displacement of the inferior polar vessels does not alter this. In our sample, the surgical procedure did not affect renal function, arterial blood pressure, or renal colour Doppler ultrasound findings.