Diagnosis Of Retrocaval Ureter Research Articles

Laparoscopic repair of retro-caval ureter: report of two cases

Retrocaval ureter is a rare congenital disorder and surgery is necessary when the patient is symptomatic or having significant functional obstructions. The two cases referred to our center with severe hydronephrosis on their right sides. In both cases further evaluation with CT scan showed the diagnosis of retrocaval ureter. The retrocaval segment of the both ureters were isolated and after the excision of the narrow segments, end to end anastomosis have been done with transperitoneal laparoscopic technique. The laparoscopic ureteroureterostomy is a safe, effective and minimally invasive procedure and should be considered as a standard treatment for retrocaval ureter.

Retrocaval ureter a rare cause of intermittent right flank pain in a 37 years old lady

A 37 years old female presented with 6 months history of intermittent right flank pain. She was otherwise fit and had no other complaints. Her lab investigations were normal. Abdominal ultrsonography revealed moderate hydronephrosis and proximal hydroureter but no calculus. Retrograde ureteropyelography findings were consistent with the diagnosis of retrocaval ureter, a rare clinical condition. Surgical exploration confirmed the presence of right retrocaval ureter. The ureter was transected and transposed anterior to inferior vena cava and ureteropelvic anastomosis was performed. Postoperative recovery was uneventful.

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

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.

Retroperitoneal laparoendoscopic single-site ureterolithotomy and ureteroureterostomy for retrocaval ureter with ureteral calculus: First case report

A 53-year-old man presented with a 6-month history of intermittent right flank pain. Radiological imaging confirmed the diagnosis of retrocaval ureter (RCU) and ureteral calculus. Retroperitoneal laparoendoscopic single-site surgery (LESS) ureterolithotomy and ureteroureterostomy was successfully performed. The operative time was 185 min and the blood loss was approximately 20 ml. The patient's postoperative course was uneventful. Postoperative analgesia was not needed. The patient was discharged on the third postoperative day. The drain and double-J stent were respectively removed at 1 and 8 weeks postoperatively. At the 3-month follow-up, nuclear scan showed no evidence of obstruction of the right kidney and the patient also remained symptom free. It may be concluded that retroperitoneal LESS repair for RCU is a feasible and safe procedure, which can be considered as a option for the management of RCU even if it is complicated by the presence of a ureteral calculus.

Retrocaval ureter: a venous anomaly causing ureteric obstruction

Introduction: The aim of this study is to report the experience in managing a rare entity, retrocaval ureter. Patients and methods: This is a retrospective study performed in a single urology unit of a tertiary referral center over a period of 8 years since October 2001. The diagnosis of retrocaval ureter was confirmed by retrograde ureteropyelogram. Symptomatic patients underwent open surgical pyelopyelostomy (ureteroureterostomy) after the ureter had been transposed to its normal anatomic position. Post surgical relief of ureteric obstruction was confirmed by 99m Tc DTPA renogram. Results: There were 5 patients with retrocaval ureter. Mean age of the patients was 33 years (range 27-39 years). Out of 5 patients 4 were males. All 5 patients were presented with right flank pain and 3 of them had haematuria and a small mobile renal stone. All patients had type 1 right-sided retrocaval ureter. Associated anomalies were seen in none of the patients. All patients were asymptomatic after the surgical correction. Post operative 99m Tc DTPA renograms were normal in all patients. Conclusion: Retrocaval ureter though rare can easily be diagnosed. Open surgical correction gives good results. DOI: 10.4038/slju.v10i1.2412 Sri Lanka Journal of Urology , 2009, 10, 18-21

Uretère rétrocave : à propos de 16 cas

To analyse the postoperative results of surgical treatment for retrocaval ureter. The authors report a retrospective clinical study of a series of 16 patients (six women and 10 men) with a mean age of 38 years (range: 15-45 years) with retrocaval ureter treated between 1975 and 2005. The mean follow-up was 18 months (range: 12 to 34 months). All patients were evaluated by the standard diagnostic protocol for the time and were treated by one of the following surgical techniques: resection of the ureter and renal pelvis to renal pelvis anastomosis; resection of the ureter and pyelo-ureteric anastomosis; resection of the ureter and oblique end-to-end uretero-ureteric anastomosis; nephrectomy. The mean operating time was 95 min. Late postoperative follow-up revealed two cases (13%) of ureteric stenosis at the site of the oblique end-to-end uretero-ureteric anastomosis. Surgical revision was performed in one patient with resection of the ureter and reanastomosis, while anterograde dilatation of the stenosis was performed in the other patient. The postoperative course was uneventful in both patients. All patients were reviewed at six months with a satisfactory result, corresponding to reduction of hydronephrosis and improvement of renal function. Over the last 30 years, the diagnosis of retrocaval ureter has become more reliable and less invasive. Satisfactory results can be obtained with conventional surgical management.

Laparoscopic Pyelopyelostomy for Retrocaval Ureter Without Excision of the Retrocaval Segment: First Report of 6 Cases

We report our series of 6 cases of retrocaval ureter that were successfully treated with a laparoscopic approach. Three men and 3 women with a mean age of 31 years (range 16 to 50) were referred to our department with a diagnosis of retrocaval ureter. One patient had a 12 mm renal pelvic calculus. A transperitoneal laparoscopic approach was used in all cases. The retrocaval segment along with some of the more proximal and distal segments of the ureter was readily mobilized. The distal part of the dilated renal pelvis was transected and the divided distal segment was repositioned to lie anterior to the inferior vena cava. The renal pelvic stone in 1 patient was readily removed at this point. Re-anastomosis was then performed over a Double-J stent placed intraoperatively using 2 rows of running 4-zero polyglactin sutures with intracorporeal knot tying. The stent was removed 4 weeks later. Excretory urography was performed 3 months after the laparoscopic procedure. Mean operative duration was 180 minutes (range 150 to 210). Patients were discharged home at a mean of 4 days (range 3 to 5). Followup excretory urogram 3 months after laparoscopic repair revealed a widely patent anastomosis with considerable improvement in hydronephrosis in all patients. To our knowledge this is the largest series of laparoscopic repair of retrocaval ureter reported to date. Laparoscopic pyelopyelostomy for retrocaval ureter without excision of the retrocaval segment is associated with an excellent outcome, minimal postoperative morbidity, short hospital stay and highly satisfactory cosmetic results.

Obstructive periureteric venous ring.

The authors have diagnosed preoperatively a true obstructing periureteric venous ring. A brief discussion of the embryology of the postrenal vena cava and a new concept concerning the diagnosis of retrocaval ureter are presented.