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

Abstract

Objective: The aim of this study was to report the experience of retroperitoneal laparoscopic ureteroplasty for nine cases of retrocaval ureter.

Material and methods: Six males and three females were referred with a diagnosis of retrocaval ureter. A retroperitoneal laparoscopic approach was taken in all patients, who were diagnosed by intravenous pyelography (IVP), computed tomography urography and retrograde pyelography. After the dilated proximal ureter was mobilized, the ureter was transected just above the retrocaval segment, which was repositioned to the anterior of the vena cava. The retrocaval segment was observed and evaluated to enable a decision as to whether or not to reserve. Then, tension-free, water-tight anastomosis was performed with absorbable sutures using intracorporeal suturing techniques over a double-J stent, which was laparoscopically inserted in an antegrade manner. The stent was removed 4–6 weeks postoperatively.

Results: The ureteroplasty was accomplished in all cases. The retrocaval segment of the ureter was reserved with a grossly normal appearance in six cases; the abnormal retrocaval segment was excised in the three other cases. The mean operative duration was 103 min (range 89–110 min) and the mean hospital stay was 7 days (range 6–9 days). No serious complications occurred. Follow-up by ultrasonography and IVP, lasting 6 months to 4 years, revealed considerable improvement in hydronephrosis and upper ureteral dilatation. No ureteral stenosis was found at the anastomotic site.

Conclusion: Retroperitoneoscopic ureteroplasty should be recommended as the first line treatment for retrocaval ureter because of its advantages of minimal invasion and shorter hospital stay than open surgery. Skilled laparoscopic anastomosis with a retroperitoneal approach can shorten the operative duration.

Keywords:

• Retrocaval ureter
• retroperitoneoscopy
• ureteroplasty

Acknowledgements

Liu Erpeng, Sun Xiao, Guo Hui: conception of the article, acquisition of the patients’ material, drafting the article. Li Faping, Liu Shukun, Wang Kaixuan: acquisition of material, analysis and interpretation of material, revising the article, final approval of the version to be published. Hou Yuchuan: conception of the article, analysis and interpretation of data, drafting and revising the article, final approval of the version to be published.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding information

This work was supported by Key scientific and technological project of Jilin province [20150204064SF].