Laparoscopic Transperitoneal Repair of Retrocaval Ureter: Case Report

Abstract

Introduction:

Retrocaval ureter is an uncommon clinical entity that generally causes upper urinary tract obstruction on the right side as the right ureter courses posterior to the inferior vena cava. ¹ The main therapeutic approach for this disease is surgical repair. ² This video describes the operative technique for laparoscopic repair of a retrocaval ureter.

Case Presentation:

The video shows the technique for a laparoscopic transperitoneal ureteroureterostomy in a 28-year-old female. The patient was admitted to the hospital with intermittent right flank pain and right hydronephrosis on ultrasonography. Further diagnostic imaging with a CT revealed proximal ureteral obstruction caused by retrocaval placement of the ureter. A laparoscopic repair of retrocaval ureter was planned. Initially, the inferior vena cava and proximal ureter were dissected until the proximal ureter was totally mobilized. The distal ureter was circumferentially dissected as well. The ureter was then divided and replaced in its normal anterior-caval position. A ureteroureteral anastomosis was performed with 4-0 polyglactin suture over a Double J-ureteral stent. The surgery was completed in 160 minutes. No intraoperative or postoperative complications occurred. ³ Oral intake and mobilization of the patient were started 6 and 24 hours, respectively, after the surgery. The drain was removed after 48 hours and the patient was discharged on postoperative day 3. The Double J-stent was removed at 6 weeks postoperatively. Postoperative 4th week CT urography imaging showed a normal course of the right ureter with diminished hydronephrosis. Follow-up was uneventful at 6 months postoperatively.

Conclusion:

The classical treatment for retrocaval ureter is replacing the ureter in its natural anatomic position with an open ureteroureterostomy. A laparoscopic approach for retrocaval ureter is an alternative to the open surgery with several benefits such as reduced pain, shorter hospital stay, and better cosmetic results.

No competing financial interests exist.

Runtime of video: 7 mins 25 secs