Laparoscopic ureterolysis and reconstruction of a retrocaval ureter

Abstract

A 32-year-old man was investigated for repeated episodes of right-sided flank pain. Ultrasonography showed a dilated right pelvicalyceal system and upper ureter as well as multiple gallstones; subsequent intravenous urogram demonstrated a retrocaval ureter. At surgery, a right-sided double-J ureteric stent was placed under fluoroscopic guidance. Initially, three laparoscopic ports were used. The dilated pelvis and upper ureter were mobilized, followed by the lower ureter. The pelvis was transected and transposed anterior to the inferior vena cava. Reconstruction was carried out with an intracorporeally sutured anastomosis over the double-J stent. A fourth port was added for completion of cholecystectomy. The patient had an uneventful recovery and was discharged on the third day. Fourteen months later he remains well, with a recent intravenous urogram showing regression of hydronephrosis. We review the previously reported cases of laparoscopic and retroperitoneoscopic reconstruction of retrocaval ureter to compare and contrast these minimal access approaches.

Treatment of Retrocaval Ureter by Retroperitoneal Laparoscopic Ureteroureterostomy: Experience on 12 Patients

“…However, the mean operative time in their study was 3 hours. 1 Although laparoscopic dismembered pyelopyelostomy, 1,7,10,15,16 LUUS 2,7,8,[12][13][14][17][18][19][20][21][22] and pyeloureterostomy 11 were successfully performed in treatment of RCU, the very limited number of cases reported worldwide did not provide sufficient knowledge about the preferable surgical technique to correct this rare disease. Most case reports describe prolonged operative times, largely because of the initial difficulties with intracorporeal suture techniques.…”

“…Over recent years, however, technological breakthroughs coupled with the intensive growth of minimally invasive laparoscopic procedures have almost replaced open surgery. 10 In 1994, Baba et al reported the first case of laparoscopic pyeloureterostomy for an RCU in 560 minutes. 11 Then, Matsuda et al performed the LUUS by using the five-port approach in 450 minutes.…”

“…13 In 2003, Bhandarkar et al reported one case treated by laparoscopic pyelopyelostomy without excising the retrocaval segment in 250 minutes. 10 However, Nagraj et al in 2006 reported the shortest operative time of only 100 minutes with LUUS by using a standard transperitoneal three-port approach. 14 Then, Simforoosh et al reported a series of 6 cases who underwent laparoscopic pyelopyelostomy for RCU without resection of the retrocaval segment, with advantages of excellent outcome, minimal postoperative morbidity, short hospital stay, and highly satisfactory cosmetic results.…”

Robot-Assisted Laparoscopic Ureteroureterostomy: Description of Technique

“…Laparoscopic ureteroureterostomy has been described previously in children. 11,12 In addition, one case of robot-assisted laparoscopic ureteroureterostomy was reported in a patient with an obstructed upper pole of a duplex collecting system and crossed renal ectopia with fusion. 9 The current series is the first to describe this operation for the treatment of ureteral obstruction in single-system ureters.…”

Circumcaval Ureter - MDCT & Retrograde Pyelography Features

“…Surgical management is reserved for the type 1 cases that are usually symptomatic. Transperitoneal and retroperitoneal laparoscopic repair of the retrocaval ureter has been described offering advantages of a shorter hospital stay and early recovery [15,16].…”