Retroperitoneoscopic ureteroplasty for retrocaval ureter: report of nine cases and literature review

Experience in Retrocaval Ureter at Saint Paul's Hospital Millennium Medical College: A Case Series

Retrocaval ureter is a rare congenital vascular anomaly described as the passage of the ureter behind the inferior vena cava (IVC) and then turning around the IVC to attain the final lateral position. The condition is usually associated with obstruction in the ipsilateral kidney, causing different degrees of hydronephrosis and complications associated with urinary stasis, such as stone formation. Imaging has a crucial role in the diagnosis and management of retrocaval ureter. CT urography may be the procedure of choice to confirm the diagnosis and avoid retrograde ureteropyelography. Indications for treatment include flank pain, recurrent infection, hydronephrosis, and stone formation due to obstruction. Surgical management is standard and can be done through either an open, laparoscopic, or robotic approach. In this case series, we are going to see two cases of retrocaval ureter in a 56-year-old male and a 14-year-old male child who presented with a right flank of less than a couple of months duration. The first case has an associated horseshoe kidney and a solitary secondary stone. Both cases were surgically managed with open ureteral division, relocation, and ureteroureterostomy. Both have uneventful post-operative follow-ups.

Very late diagnosed Retrocaval ureter: A case report of a very rare entity in Cameroon, sub-Sahara Africa

Introduction and importance

Case presentation

Clinical discussion

Conclusion

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Retrocaval ureter (RCU) is a very rare congenital anomaly.

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Most cases are asymptomatic and late diagnosis can lead to an obstructive nephropathy which can be very harmful to the kidney.

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This paper highlights difficulties in diagnosis and management of a case of RCU, late diagnosed, with functional deterioration of the kidney, in a ressource-poor setting in Africa.

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We describe the most complex case of RCU reported in the medical literature in sub-Sahara Africa.

Retrocaval ureter with ureteral calculus: Case report

Retrocaval ureter, which also called circumcaval ureter, is a rare abnormal development where the vena cava compresses the upper segment of ureter leading to different grades of hydronephrosis. We reported a case of a 50-year-old man has a retrocaval ureter with a stone in the loop behind the vena cava. Surgical correction with extraction of the stone was done successfully. On follow up, there was no hydronephrosis. In conclusion synchronized retrocaval ureter with a stone in the ureter is considered a surgical challenge to the urologist and it needs careful investigations to make the diagnosis.

Laparoscopic Dismembered Repair in Two Patients with Retrocaval Ureter

Retrocaval ureter (RCU) or circumcaval ureter is a rare cause of congenital hydronephrosis. The surgical correction of RCU should be performed in all patients with obstruction and hydronephrosis symptoms, lumbar pain, urinary tract infections, hematuria, or urolithiasis. Traditionally, an open surgical approach was used for the treatment of RCU. Nowadays, surgical correction of these anomalies is performed using minimally invasive techniques. We report on two cases treated with our standardized laparoscopic technique using only three 5-mm trocars. The proposed approach could be considered as the first-line treatment for RCU.

Retrocaval Ureter: Report of Two Cases

Retrocaval ureter (RCU) is a rare congenital anomaly in which the ureter passes posterior to the inferior vena cava (IVC). A little over 200 cases have been reported worldwide since Hochstetter's first report in 1893. We present two cases of retrocaval ureter which were successfully managed at the Cape Coast Teaching Hospital in Ghana. Case 1. A 55-year-old woman presented with a history of dull right flank pain of 2 years duration. Physical examination and basic laboratory investigations performed on her were normal. Abdominal ultrasound showed right hydronephrosis and a retrograde right ureteropyelogram (RPG) showed right hydroureteronephrosis with an "S" shaped proximal ureter. A diagnosis of retrocaval ureter was made and confirmed at surgery. Case 2. A 25-year-old man presented with dull intermittent right flank pain of 1 year duration. Clinical examination and laboratory investigation were normal. Abdominal ultrasound showed right hydronephrosis and a CT urogram made a diagnosis of retrocaval ureter which was confirmed at surgery. Conclusion. Retrocaval ureter is a rare congenital anomaly that is now increasingly being reported. Surgical treatment of symptomatic cases successfully relieves symptoms.

Laparoscopic and robotic transperitoneal repair of retrocaval ureter: A comparison of the surgical outcomes from two centres with a comprehensive literature review

BACKGROUND

The use of minimally invasive surgical approaches for the repair of retrocaval ureter (RCU) has been increased in time. However, the results of the robotic approach have not yet been compared with those of open or laparoscopic approaches. We aimed to compare the results of laparoscopic and robotic transperitoneal repair of RCU from two centres.

PATIENTS AND METHODS

Initially, we performed a systemic literature search using MEDLINE/PubMed and Google Scholar about the RCU. Finally, a comparison of the efficacy and outcomes of the laparoscopic and robotic transperitoneal approaches for RCU repair was performed with the results of two centers.

RESULTS

The mean age was 27.5 ± 3.6 years. The mean operative time was 147 ± 63.6 min. The median estimated blood loss was 100 (20-423.9) ml. The median drain removing time and hospital stay were 2 (2-3) and 3 (2-4) days, respectively. The mean follow-up period was 17.85 ± 14.6 months. All of the parameters were similar between the laparoscopic and robotic repair groups except for the mean operative time. It was significantly shorter in robotic repair group than those of laparoscopic repair group (P = 0.02). Furthermore, a ureteral stricture of the anastomotic segment was detected in a patient treated with laparoscopy during the follow-up.

CONCLUSIONS

Robotic transperitoneal approach may shorten the operative time enabling a greater comfort in repair of RCU.

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

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.

Comparison of the efficacy and safety of retroperitoneal laparoscopic and open surgery for the correction of retrocaval ureter

OBJECTIVE

The aim of this study was to compare the clinical efficacy and safety of retroperitoneal laparoscopic and open surgery for the correction of retrocaval ureter.

PATIENTS AND METHODS

Clinical data of 14 patients with retrocaval ureter were analyzed retrospectively. Among them, nine were treated by open surgical therapy and five by retroperitoneal laparoscopic surgery. The ureter was transpositioned to a normal anatomic position followed by laparoscopic intracorporeal uretero and ureteric anastomosis.

RESULTS

Open surgery was successfully performed in nine cases. The mean surgery time was 95.6±22.0 min, and blood loss was 108.6±34.5 mL. The mean hospitalization time was 14.8±1.1 days, and the recovery time was 52.8±1.3 days. Retroperitoneal laparoscopic surgery was successfully performed in five cases without conversion to open surgery and without severe perioperative complications. The mean surgery time was 112.0±42.1 min, and blood loss was 45.3±15.1 mL. The mean hospitalization time was 7.3±1.9 days, and the recovery time was 23.6±2.4 days. Postoperative urine leakage occurred in one patient. No postoperative ureter stenosis occurred in patients who were treated by retroperitoneal laparoscopic surgery.

CONCLUSION

Retroperitoneal laparoscopic ureteroplasty in patients with retrocaval ureter is safe and effective with less trauma and faster recovery and could be used as first choice for the treatment of retrocaval ureter.