Transperitoneal laparoscopic repair of retrocaval ureter: Our experience and review of literature

A case of retrocaval ureter with robot-assisted ureteral reconstruction

Introduction

Retrocaval ureter is a rare congenital anomaly that causes ureteral obstruction. Because of the rarity of retrocaval ureter, only a few cases of open, laparoscopic, or robot-assisted surgery have been reported. We herein report a case of retrocaval ureter that was successfully reconstructed with robot-assisted surgery.

Case presentation

A 24-year-old woman was incidentally diagnosed with right hydronephrosis on ultrasonography. Computed tomography revealed retrocaval ureter, and the right hydronephrosis was attributed to the retrocaval ureter. The patient underwent robot-assisted right ureteral reconstruction in the left lateral decubitus position. No intraoperative or postoperative complications occurred, and no right hydronephrosis was observed 6 months after the operation.

Conclusion

The present case demonstrated the feasibility and efficacy of robot-assisted ureteral reconstruction for retrocaval ureter.

Long-term, single-center study comparing open and laparoscopic procedures for congenital midureteral obstruction in children

PURPOSE

To compare the safety and outcomes of open and laparoscopic procedures in the management of congenital midureteral obstruction in children (CMO).

METHODS

Between February 2008 and February 2022, a total of 18 patients underwent open ureteroureterostomy (OU group), and 26 underwent laparoscopic ureteroureterostomy (LU group). The operative time, postoperative hospital stay, hospital costs, postoperative complications, and success rates of the two groups were compared.

RESULTS

The median age of the patients was 59 months, with 29 patients presenting with asymptomatic hydronephrosis, 12 with intermittent abdominal pain, and 3 with flank mass. The median follow-up time was 42 months, and all patients were successfully treated surgically. The operative time and postoperative hospital stay in the LU group were shorter than those in the OU group (106.3 ± 21.4 vs. 85.8 ± 16.5 min, 11.6 ± 1.9 vs. 8.3 ± 1.7 days, respectively; p < 0.05). The OU group had two postoperative complications, both of which were classified as Clavien-Dindo grade II based on the Clavien-Dindo classification. One case of postoperative complication occurred in the LU group, which was classified as Clavien-Dindo Grade II. There was no significant statistical difference in complications between the two groups (P > 0.05).

CONCLUSIONS

Our data showed that laparoscopic ureteroureterostomy is a safe and effective treatment for congenital midureteral obstruction in children, and provides several advantages, including fewer postoperative complications, shorter postoperative hospital stay, and a shorter operative time. Laparoscopic procedures should be the first choice for treating children with congenital midureteral obstructions.

Pyeloplasty for a Child With a Retrocaval Ureter: A Case Report

Retrocaval ureter, also known as a circumcaval ureter or pre-ureteral vena cava, is a rare entity in which the patient's ureter passes backward to the inferior vena cava (IVC). The IVC compresses the upper portion of the ureter resulting in varying degrees of hydroureteronephrosis. We report a case of a child with retrocaval ureter malformation that was incidentally diagnosed while investigating for intermittent right renal colic, which was successfully treated by subcostal pyeloplasty. This case highlights the importance of radiographic imaging to diagnose retrocaval ureter, with computed tomography as a definitive method, but other modalities, including magnetic resonance imaging, ultrasound, and pyelography, are also helpful.

Transperitoneal laparoscopic ureteropyeloplasty of retrocaval ureter: Single surgeon experience and review of literature

INTRODUCTION

Retrocaval ureter (RCU) is a rare congenital abnormality, secondary to anomalous development of inferior vena cava (IVC) presenting as ipsilateral obstruction needing surgical intervention. The aim of this article is to present surgical techniques and outcome of transperitoneal laparoscopic ureteropyeloplasty in patients with RCU treated by a single surgeon at a tertiary care center and with review of literature.

MATERIAL AND METHODS

We conducted a retrospective, institutional review board approved chart review of patients who underwent transperitoneal laparoscopic ureteropyeloplasty for RCU at our unit between January 2010 and December 2020. A total of 10 patients were identified. Preoperative evaluation involved a computed tomography-intravenous urography in addition to the conventional evaluation. All the patients underwent dismembered transperitoneal laparoscopic ureteropyeloplasty over a Double J stent. Data analyzed included the demographic profile, operative time difficulty if any, postoperative, intraoperative complications and functional outcome.

RESULTS

All cases were completed laparoscopically and no open conversion was required. Average operating time was 96.6 minutes ± 8.16. Average blood loss was 71 ± 14.49 mL with an analgesia requirement of 115 ± 33.74 mg. One patient developed postoperative urinary leak and responded to percutaneous nephrostomy drainage. Patients were followed up for 3 to 12 months with a serial ultrasound and a follow-up diethylene-triamine-penta-acetic acid renal scan at 3 months to rule out any anastomotic site obstruction.

CONCLUSION

Transperitoneal laparoscopic ureteropyeloplasty for RCU was associated with minimal morbidity and good outcomes.

Anomalies of Inferior Vena Cava: Implications and Considerations in Retroperitoneal Surgical Procedures

Anomalies of the inferior vena cava pose a great challenge to surgeons. Although uncommon, these congenital vascular malformations may have significant surgical implications. Awareness of their presence is essential to avoid inadvertent injury and major bleeding during retroperitoneal procedures. An accurate preoperative diagnosis and detailed planning play a crucial role to obtain successful outcomes when confronted with them. Several surgical techniques have been recommended to protect these anomalous venous structures. The aim of this review is to contribute to the knowledge of the most common types of anomalies of inferior vena cava encountered during retroperitoneal procedures. With this purpose, a summary of their anatomy, embryology, incidence, diagnosis and intra-operative management is presented.

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: a meta-analysis of prevalence

INTRODUCTION

Retrocaval ureter is a congenital abnormality of the right ureter, which has been shown, in rare cases to cause clinical symptoms, mainly due to the development of ureterohydronephrosis.

PURPOSE

The purpose of this article is to identify the prevalence of the retrocaval ureter, and to emphasize its clinical and surgical importance.

DESIGN

A meta-analysis of prevalence, on cases obtained from PubMed, Web of Science, and Scopus databases.

RESULTS

A total number of 13 studies contained data that allowed us to estimate the prevalence of the retrocaval ureter, which was identified overall in 9 cases, out of 18,493 subjects. The overall prevalence of retrocaval ureter was 0.13%, with a 95% confidence interval between 0.06 and 0.27%. There was no publication bias, all studies being under the funnel.

CONCLUSIONS

The overall prevalence of retrocaval ureter is 0.13%. Even if this is obviously a rare condition, its presence must be suspected by practitioners, especially in the presence of urological symptoms without a clear cause.

Laparoscopic retroperitoneal approach for retrocaval ureter in children

PURPOSE

Retrocaval ureter (RCU) is a rare congenital anomaly and published data on pediatric laparoscopic management are poor. The aim of this study was to report our experience of retroperitoneal laparoscopic approach for management of RCU in children.

METHODS

A retrospective review of data from patients treated for RCU between 2002 and 2018 in our institution was performed. All patients were positioned in a flank position and underwent a three-port (5-mm optical trocar and two 3-mm trocars) laparoscopic retroperitoneal ureteroureterostomy. Anastomosis was made by 6/0 absorbable sutures. A JJ stent was always inserted.

RESULTS

Five patients with a median age of 94 months (5-152) were operated on and followed up for a median time of 103 months (46-201). Median operating time was 200 min (160-270). No conversion and no transfusion occurred. Median hospital stay was 2 days (1-4). Ureteral stent was removed after 52 days (47-82). Complications included pyelonephretis (N = 1). In all cases, hydronephrosis decreased postoperatively.

CONCLUSIONS

Retroperitoneal laparoscopic approach for RCU is safe and effective in children. Our video demonstrates different patients with specific surgical details to show how to manage these children. The global vision of the upper tract by laparoscopy leads to optimal management of these children even if the anomaly was not detected preoperatively.

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.