Laparoscopic transperitoneal pyelopyelostomy and ureteroureterostomy of retrocaval ureter: Report of two cases and review of the literature

Abstract

We report two cases of retrocaval ureter that were successfully treated by a laparoscopic transperitoneal approach. Presentation of both these cases was with flank pain. Ureteroureterostomy using an intracorporeal suture technique was performed for one, and pyelopyelostomy for the other case. Operative time was 120 min and 110 min, respectively. Pyelopyelostomy was technically easier to perform than ureteroureterostomy that required an extra fourth port insertion to facilitate dissection. With increasing experience with the intracorporeal suturing laparoscopic technique of either pyelopyelostomy or ureteroureterostomy should be the first choice for retrocaval ureter.

Treatment of Retrocaval Ureter by Retroperitoneal Laparoscopic Ureteroureterostomy: Experience on 12 Patients

“…However, the mean operative time in their study was 3 hours. 1 Although laparoscopic dismembered pyelopyelostomy, 1,7,10,15,16 LUUS 2,7,8,[12][13][14][17][18][19][20][21][22] and pyeloureterostomy 11 were successfully performed in treatment of RCU, the very limited number of cases reported worldwide did not provide sufficient knowledge about the preferable surgical technique to correct this rare disease. Most case reports describe prolonged operative times, largely because of the initial difficulties with intracorporeal suture techniques.…”

“…Although the retrocaval segment could be easily freed from the vena cava laparoscopically, the decision of whether to resect or preserve the retrocaval segment of the ureter has been controversial. 6 Singh et al 7 and Li et al 8 suggested that the retrocaval segment of the ureter was reserved when they had a grossly normal appearance without obvious stenosis, and the obvious stenotic retrocaval segment of the ureter was excised. Zhang et al 9 suggested excising the retrocaval segment if a 8F catheter could not pass through the segment easily.…”

Retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter: A report of 15 cases

“…However, in the past decade, with the intensive growth of minimally‐invasive surgery, laparoscopic operation has gradually replaced open surgery, because of less bleeding and tissue damage, rapid recovery and cosmetic results. Transperitoneal LUUS can provide large operative space for ureteroureterostomy . Retroperitoneal LUUS affords rapid and direct access to the renal pelvis and ureter without violating the peritoneal cavity .…”

“…Transperitoneal LUUS can provide large operative space for ureteroureterostomy. [12][13][14] Retroperitoneal LUUS affords rapid and direct access to the renal pelvis and ureter without violating the peritoneal cavity. [15][16][17][18] Which approach is better remains controversial.…”

Is There an Ideal Port Position for Laparoscopic Urological Procedures?

“…Mobilization of the ureter in the inter aortocaval region require additional 5 mm port to be inserted at the flank. 17 LESS approach to lower ureter through suprapubic transvesical port has been described. 26 …”