Investig Clin Urol.  2019 Mar;60(2):108-113. 10.4111/icu.2019.60.2.108.

Transperitoneal laparoscopic ureteroureterostomy with excision of the compressed ureter for retrocaval ureter and review of literature

• Seo IY
• Oh TH
• Jeon SH

• KMID: 2438821
• DOI: http://doi.org/10.4111/icu.2019.60.2.108

Abstract

PURPOSE
We present surgical techniques and operative results of laparoscopic reconstruction for patients with retrocaval ureter (RCU) and review similar papers.
MATERIALS AND METHODS
Ten patients with RCU were enrolled in this study from April 2005 to January 2017. The mean age of 7 males and 3 females was 40.5 years old. The chief complaint was flank pain in 6 patients; the remaining patients were detected incidentally. All patients showed hydronephrosis and typical S-shaped deformity of the ureter on imaging studies. Five patients showed obstructed patterns on the renal scans. Two surgeons performed laparoscopic ureteroureterostomies with transperitoneal approaches including excision of the compressed ureter. Double-J ureteral stents were inserted intraoperatively. The operative and follow-up results were checked and compared with published papers.
RESULTS
All laparoscopic reconstructions were successfully completed without conversion to open surgery. The mean operative time was 199.6 minutes. The estimated blood loss was 154.4 mL. No operative complications were encountered. There were no obstruction and symptom after the mean follow-up of 40.7 months. We found 7 papers from PubMed, which had more than five cases of laparoscopic reconstruction of RCU. We reviewed and summarized the clinical and operative parameters.
CONCLUSIONS
Our results show that transperitoneal laparoscopic ureteroureterostomy with excision of the compressed ureter is a safe and effective treatment for RCU. Data from published papers and ours summarize clinical parameters of RCU, and suggest that the laparoscopic reconstruction can be considered as the standard treatment for it.

Keyword

Laparoscopy; Retrocaval ureter; Ureteral obstruction

MeSH Terms

Congenital Abnormalities
Conversion to Open Surgery
Female
Flank Pain
Follow-Up Studies
Humans
Hydronephrosis
Laparoscopy
Male
Operative Time
Retrocaval Ureter*
Stents
Surgeons
Ureter*
Ureteral Obstruction

Figure

• 

  Fig. 1 (A) A right side retrocaval ureter (dotted circle) with a dilated renal pelvis (arrow) on the axial computed tomographic image. (B) The retrocaval ureter showing a typical S-shaped deformity on the retrograde pyelogram preoperatively. (C) Normal position of the ureter without evidence of obstruction on the intravenous pyelogram at 3 months postoperatively.

• 

  Fig. 2 Laparoscopic findings. (A) Dilated renal pelvis and retrocaval ureter behind inferior vena cava (IVC) was mobilized. (B) The retrocaval ureter was transected using cold scissors. Preoperative inserted guide wire (arrow) was identified. (C) Sutures were performed between repositioned ureter and renal pelvis after insertion of double-J ureteral stent (arrow). (D) Anastomosis was closed with interrupted sutures. The ureter was repositioned anterior to IVC.

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