Ces Urol 2019, 23(4):292-294

Laparoscopic transperitoneal reconstruction of retrocaval ureter - a case report

Marcel Drlík, Radim Kočvara

Centrum dětské urologie, Urologická klinika, VFN a 1. LF UK, Praha

Aim of study: Retrocaval ureter is a rare congenital obstructive uropathy resulting from a vascular abnormality - the posterior cardinal vein persisting as a segment of the infrarenal vena cava that entraps the right proximal ureter. Although an open access to the reconstruction is still considered as a gold standard, a minimally invasive approach was reported in the literature. Authors present a case report of a 12-year-old girl with a symptomatic retrocaval ureter managed with laparoscopic access. This is the first report in the Czech literature. Material and method: A 12 years-old girl presented with recurrent attacks of right-sided flank pain of two weeks duration, associated with vomiting. Ultrasound showed right hydronephrosis and dilatation of the upper part of the right ureter. Intravenous urography showed a typical ureteral "S shaped deformity" suggesting retrocaval ureter. CT urography confirmed the diagnosis and the patient was scheduled for laparoscopic transperitoneal reconstruction. The girl was placed under general anesthesia. A Foley catheter was inserted and the patient placed in a lateral decubitus position. A 10 mm laparoscopic port was placed at the umbilicus and two 5 mm working ports were placed under direct vision in the midline above and below the umbilicus. The peritoneum was opened lateraly to ascending colon and retroperitoneal space was exposed. Then, the dilated pelvis and dilated proximal ureter was identified and dissected down to vena cava. The lower ureter was partially mobilised and the retrocaval segment was entirely separated from vena cava. The lower part of dilated pelvis was stabilized with a stay suture and pelvis was divided up to pyeloureteral junction. The ureter was repositioned to lie anterior to the vena cava and a retrocaval part of the ureter was excised. A standard laparoscopic dismembered pyeloureterostomy using two 5/0 Vicryl continous sutures was performed, protected by a 6 French 28 cm double J stent inserted through abdominal wall under ribs. Drain was not inserted, Haemolog clips were used to close peritoneum.

Results: The operating time was 237 min and blood loss was minimal (< 25 ml). The girl recovered uneventfully. On the postoperative 4^th day, the urethral catheter was removed and the patient was discharged on the 5^th day postoperatively. Stent removal was done 7 weeks later. Ultrasound performed 3,5 months after reconstruction confirmed complete resolution of right renal pelvic and ureteric dilatation.

Conclusion: Laparoscopic transperitoneal approach of retrocaval ureter is a safe and feasible alternative to standard open access. It provides well known advantages associated with minimally invasive surgery.

Keywords: Laparoscopy, retrocaval ureter, child, urinary obstruction.

Received: August 2, 2019; Accepted: September 30, 2019; Prepublished online: September 23, 2019; Published: December 10, 2019