Laparoscopic transposition for crossing vessels (vascular hitch) in pure extrinsic pelvic-ureteric junction obstruction: a successful case report of a 2-year-old infant with horseshoe kidney

Background Pediatric hydronephrosis induced by pelvic-ureteric junction obstruction (PUJO) is treated by dismembered pyeloplasty (DP) via open and laparoscopic surgery. The etiology of PUJO involves both intrinsic stenosis and extrinsic compression of crossing vessels (CVs). PUJO owing to CVs is also treated by DP, as there is no consensus concerning this vascular condition. We encountered a 2-year-old infant with pure extrinsic PUJO combined with horseshoe kidney who successfully underwent laparoscopic transposition for CVs (vascular hitch). Case presentation A 2-year-old boy was prenatally diagnosed with left multicystic dysplastic kidney (MDCK) and right hydronephrosis and received a definitive diagnosis after birth. At 6 months old, renal scintigraphy revealed a non-functioning pattern in the left kidney and an obstructive pattern in the right, showing no response to furosemide loading. The patient also had recurrent urinary tract infection, and his right hydronephrosis gradually worsened. We decided to perform surgery for the right PUJO. Preoperative enhanced computed tomography detected three right renal vessels independently branching from the abdominal aorta. The middle renal vessels were located at the ventral side of the pelvis and coincident with the site of PUJO. These vessels were suspected of being CVs. The patient underwent laparoscopic surgery electively. A 5-mm trocar was inserted at the umbilicus for a 5-mm, 30° rigid scope. Two additional ports were then inserted under laparoscope inspection. The dilated right pelvis and CVs were detected after ascending colon mobilization. To confirm the pathogenesis of PUJO, the CVs were dissected and taped. After taping the CVs, an intraoperative diuretic test was performed using furosemide loading. Peristalsis of the right ureter was recognized, and the extrinsic PUJO owing to the CVs was definitively confirmed. We therefore performed transposition for the CVs (vascular hitch procedure). The CVs were mobilized in the cranial direction and those were wrapped by dilated pelvis. The post-operative course was uneventful. The renal scintigraphy findings improved and showed a favorable response of furosemide loading. Conclusions The laparoscopic vascular hitch procedure is minimally invasive and effective for extrinsic PUJO due to CVs. Anastomotic stricture after Anderson and Hynes DP can be prevented by appropriate patient selection.

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.

Perancangan Aplikasi Pencatatan Data Manifes Penumpang Kapal Penyeberangan Danau Toba Menggunakan Web

Lake Toba Tourism Area, has the potential for natural tourism which is formed from super volcanic activities so that it makes it one of the favorite tourist attractions in Indonesia. The crossing ship is the main transportation in the Lake Toba tourism area and is a favorite choice for people around Lake Toba and tourists who want to visit Samosir Island. Passenger Manifest Data is a very important document in the process of transportation, especially airplanes and ships, including crossing ships on Lake Toba. The manifest contains data on passengers, crew members and various items transported by the mode of transportation. Manifest documents are also useful for the process of disbursing insurance for transportation accidents. Passenger Manifest data using crossing ships on Lake Toba currently only records the number of passengers and the number of vehicles riding the ship, but does not record the name of the passenger. Passenger manifest data application is needed to manage the manifest data of crossing ship passengers on Lake Toba, with the aim of facilitating monitoring of crossing activities and the process of identifying passenger crossing vessels. This research will produce an application to recording Passenger Manifest of crossing ship in Lake Toba. The application is based on web, so it will be easily accessed anywhere, and can only be accessed by the North Sumatra Transportation Office. This application can be used to make it easier for the parties involved in supervising and controlling the list of ship passengers who travel on Lake Toba, so that it can reduce the risk of accidents and misuse of the number of boat loads from the permit.