PUJO: Hellstrom principle revisited
Reviewed by Henrik Steinbrecher

This paper describes the result of four out of twenty-three cases (two males, two females) of pelvi-ureteric junction obstruction - PUJO - (mean age 18.25 years, range 16-20), mean follow-up two years (range six months – three years) that were treated with the retroperitoneoscopic posterior pyelopexy hitch rather than a dismembered pyeloplasty or an anterior vascular hitch with no recurrence and shorter operative time than the laparoscopic dismembered pyeloplasty. The study was non-randomised. The intraoperative findings included a) a funnel shaped and dependent pelvis, b) decreased dilation of the pelvis despite furosemide challenge, c) absence of gross pathological abnormality on inspection of PUJ. The mobile pelvis was fixed posteriorly to the psoas muscle using absorbable sutures. This study outlines a further technique that is being adopted in place of a dismembered pyeloplasty in the treatment of PUJO. Its long-term outcome is still to be assessed. 

Retroperitoneoscopic pyelopexy for pelviureteric junction obstruction with crossing vessel in adolescents: Hellstrom principle revisited.
Assam A, Hashad M, Badawy H.
JOURNAL OF PEDIATRIC UROLOGY
2013;9:415-18.