Laparoscopic Ureteroureterostomy for Retrocaval Ureter

Abstract

Introduction:

Retrocaval ureter is a rare congenital anomaly occurring in 1 in 1500 people. It is a condition in which the ureter deviates medially and passes behind the inferior vena cava, winding around it and crossing in front of it from the medial to the lateral side. Although the abnormality is congenital, it does not present until the third or fourth decade of life. ¹ It commonly presents with right lumbar pain, dull aching or intermittent (renal colic), recurrent urinary tract infections, and microscopic or gross hematuria. There is a high incidence of calculi because of stasis, and an Intravenous Urography (IVU) usually shows an “S” or “fishhook” deformity of the ureter. ¹ We present an operative video of a patient with right-sided retrocaval ureter for which we performed a laparoscopic ureteroureterostomy.

Case Report:

A 22-year-old man presented with pain in right loin on and off for the past 3 months. The results of the clinical examination were unremarkable. Ultrasonography revealed right hydronephrosis with dilated upper ureter. Intravenous urography revealed a fishhook deformity of the upper ureter with proximal obstruction suggestive of retrocaval ureter. We did a laparoscopic transperitoneal ureteroureterostomy over a Double-J stent, and the procedure was uneventful. It took 4 hours. Patient was ambulated on day 1. Patient had an uneventful recovery. He was discharged on day 5. The stent has been removed, and the patient is now asymptomatic.

Discussion:

The first reports of a laparoscopic treatment for this condition were from Japan: initially, Baba's team from Keio in 1994 ² followed by Matsuda's group from Osaka ³ and Ishitoya's group from Kurashiki in 1996. ⁴ They described dissection of the anomalous ureter, division, and laparoscopic re-anastomosis (ureteroureterostomy). In the first case the procedure took 9 hours 20 minutes, but the operative time now is generally 2 to 3 hours. Although the majority of early reports favor the transperitoneal route, this reconstructive procedure is also performed retroperitoneally over a Double-J ureteric stent as described by Abbou's group in 1999. ⁵ It is possible to perform an extracorporeal anastomosis, which may reduce operative time in those not adept at laparoscopic suturing. ⁶

Conclusion:

Comparisons between historical reports about open surgery and laparoscopic surgery for retrocaval ureter have clearly shown the advantages of minimally invasive approaches like less intraoperative bleeding, a shorter postoperative hospital stay, reduced postoperative pain, earlier return to daily activities, and a significant, superior esthetic effect while preserving therapeutic efficacy.

The complete abstract and author disclosures are no longer available.

Runtime of video: 6 min 35 sec