Real-time intraoperative perfusion assessment using indocianine green in pediatric extrinsic ureteropelvic junction obstruction with crossing vessel.

Giulia Martini; Girolamo Mattioli; Giulia Rotondi; Venusia Fiorenza; Marcello Carlucci

doi:10.1016/j.jpurol.2026.105787

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Real-time intraoperative perfusion assessment using indocianine green in pediatric extrinsic ureteropelvic junction obstruction with crossing vessel.

Giulia Martini·Girolamo Mattioli·Giulia Rotondi·Venusia Fiorenza·Marcello Carlucci

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Abstract

INTRODUCTION: In vascular hitch (VH) particular attention must be paid to preserving lower pole perfusion. Hypoperfusion is normally excluded by macroscopic visual assessment of parenchyma appearance. Our aim is to explore the possible role of indocyanine green (ICG) in highlighting focal hypoperfusion. MATERIALS AND METHODS: This prospective study included pediatric patients with UPJO caused by crossing vessels, treated with robot-assisted VH. Intraoperative evaluation assessed UPJ appearance, reduction of hydronephrosis after vessel mobilization, and the adequacy of pelvic drainage during diuretic testing. ICG was used to assess renal perfusion via NIRF imaging. A 25 mg ICG solution was prepared in 10 mL and administered in 1 mL doses. Fluorescence distribution, operative time, and complications were recorded. Follow-up at 3, 6, and 12 months included clinical evaluations, blood pressure measurements, and Doppler ultrasound. RESULTS: Eight patients (median age 8years) were enrolled between October 2023 and February 2025. ICG assessed renal perfusion post-procedure; one case of focal hypoperfusion due to vessel tension was resolved with intraoperative revision. At a median follow-up of 18 months, no hypertension, pain, or UTIs were observed. Ultrasound demonstrated improved hydronephrosis and normal Doppler flow. CONCLUSION: ICG angiography is a safe and effective tool for the real-time assessment of renal perfusion during pediatric VH procedures.

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Humans Indocyanine Green Female Prospective Studies Child Male Kidney Pelvis Ureteral Obstruction Child, Preschool Coloring Agents Robotic Surgical Procedures Intraoperative Care Hellstrom-Chapman Indocyanine green Robotic Surgery UPJO Journal Article

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Giulia Martini, Girolamo Mattioli, Giulia Rotondi, Venusia Fiorenza, Marcello Carlucci. 2026-02-03. Real-time intraoperative perfusion assessment using indocianine green in pediatric extrinsic ureteropelvic junction obstruction with crossing vessel.. https://doi.org/10.1016/j.jpurol.2026.105787

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