Videosurgery
Laparoscopic ureteroureterostomy for the treatment of retrocaval ureter
Mario Álvarez-Maestro1-3, Diego M Carrion1-2, Juan Gómez Rivas1-3, Jose Antonio Moreno Valle1-3, Jose Quesada-Olarte1-2, Alfredo Aguilera Bazan1-3, Luis Martínez-Piñeiro1-3
1Department of Urology, La Paz University Hospital, Madrid, Spain
2Universidad Autonoma de Madrid, Madrid, Spain
3La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
Citation: Álvarez-Maestro M, Carrion D M, Rivas J G, et al. Laparoscopic ureteroureterostomy for the treatment of retrocaval ureter. www.ceju.online/journal/10000/retrocaval-ureter-laparoscopy-ureteroureterostomy-1822.php
Key Words: laparoscopy • ureteroureterostomy • retrocaval ureter • minimally invasive surgery • ureteral surgery

Retrocaval or circumcaval ureter is a rare congenital anomaly due to an anomalous development of the inferior vena cava (approximate incidence of one in 1000 live births), three to four times more common in males and with a predominance for the right side [1, 2]. The classification of Bateson and Atkinson differentiates two types: type I has an 'S' or 'fishhook' appearance and usually presents with symptomatic obstruction of the affected urinary tract, and type II, which has a less angulated 'sickle-shaped' ureteral deformity [3]. Since the first reported surgical treatment for this condition, described by Anderson and Hynes in 1949 [4], minimally invasive surgical approaches have gained popularity in the last years [5–8]. We present in the following video our technique for transperitoneal laparoscopic ureteroureterostomy of a right retrocaval ureter without excision of the retrocaval segment.
We present the case of a 38-year-old male, who was seen in the emergency department for a right flank pain with associated acute renal failure. An abdominal ultrasound performed in the acute setting described findings compatible with of right ureteropelvic junction obstruction. The patient underwent a right double J stent placement as an emergency procedure and was discharged on the next day with improvement in symptoms and laboratory analysis (serum creatinine and eGFR). As part of the outpatient evaluation, a CT scan was performed, showing a right retrocaval ureter. A laparoscopic transperitoneal approach was chosen for the elective surgical repair.
In the left lateral decubitus position, a camera trocar, and 3 working trocars were positioned. Our surgical technique is described in a step-by-step manner in the video. The patient recovered well from surgery and was discharged home 48 hours later. The double J stent (placed during surgery) was removed 6 weeks after, and right side distal urine passage was seen in intravenous pyelography. An improvement was also noted in renal scintigraphy and diuretic renogram.

References
  1. Zhang XD, Hou SK, Zhu JH, Wang XF, Meng GD, Qu XK. Diagnosis and treatment of retrocaval ureter. Eur Urol. 1990;18:207
  2. Yarmohammadi A, Mohamadzadeh Rezaei M, Feizzadeh B, Ahmadnia H. Retrocaval ureter: a study of 13 cases. Urol J. 2006;3:175-9
  3. Bateson EM, Atkinson D. Circumcaval ureter: a new classification. Clin Radiol. 1969;20:173-7
  4. Anderson JC, Hynes W. Retrocaval ureter; a rare case diagnosed pre-operatively and treated successfully by a plastic operation. Br J Urol. 1949;21:109-14
  5. Salonia A, Maccagnano C, Lesma A, Naspro R, Suardi N, Guazzoni G, et al. Diagnosis and treatment of the circumcaval ureter. Eur Urol Suppl. 2006;5:449-62
  6. Asimakopoulos AD, D'Orazio A, Pereira CF, Hoepffner JL, Mugnier C, Gaston R, et al. Surgery illustrated – focus on details: laparoscopic repair of obstructing retrocaval ureter. BJU Int. 2011;107:1330-4
  7. Li HZ, Ma X, Qi L, Shi TP, Wang BJ, Zhang X. Retroperitoneal laparoscopic Ureteroureterostomy for retrocaval ureter: report of 10 cases and literature review.
  8. Alkhudair WK, Seyam R, Al Zahrani HM, Al Otaini MF, Al Taweel W. Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment. Can Urol Assoc J. 2012;6:E38-41 doi: 10.5489/cuaj.10121.
Article history
Submitted: 25 November, 2018
Accepted: 26 December, 2018
Published online: 27 December, 2018
doi: 10.5173/ceju.2018.1822
Corresponding author
Diego M Carrion
email: diegocarrionm@hotmail.com
Conflicts of interest:  The authors declare no conflicts of interest.
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