Laparoscopic retroperitoneal approach for retrocaval ureter in children.

PURPOSE: Retrocaval ureter (RCU) is a rare congenital anomaly and published data on pediatric laparoscopic management are poor. The aim of this study was to report our experience of retroperitoneal laparoscopic approach for management of RCU in children. METHODS: A retrospective review of data from patients treated for RCU between 2002 and 2018 in our institution was performed. All patients were positioned in a flank position and underwent a three-port (5-mm optical trocar and two 3-mm trocars) laparoscopic retroperitoneal ureteroureterostomy. Anastomosis was made by 6/0 absorbable sutures. A JJ stent was always inserted. RESULTS: Five patients with a median age of 94 months (5-152) were operated on and followed up for a median time of 103 months (46-201). Median operating time was 200 min (160-270). No conversion and no transfusion occurred. Median hospital stay was 2 days (1-4). Ureteral stent was removed after 52 days (47-82). Complications included pyelonephretis (N = 1). In all cases, hydronephrosis decreased postoperatively. CONCLUSIONS: Retroperitoneal laparoscopic approach for RCU is safe and effective in children. Our video demonstrates different patients with specific surgical details to show how to manage these children. The global vision of the upper tract by laparoscopy leads to optimal management of these children even if the anomaly was not detected preoperatively.

Laparoscopic and robotic-assisted repair of retrocaval ureter in children: a multi-institutional comparative study with open repair.

PURPOSE: This retrospective study aimed to report a multi-institutional experience with laparoscopic and robotic-assisted repair of retrocaval ureter in children and to compare outcome of minimally invasive surgery (MIS) with open repair. METHODS: The records of all children, who underwent MIS and open repair of retrocaval ureters in six international pediatric urology units over a 5-year period, were retrospectively collected. Data were grouped according to the operative approach: a laparoscopic group (G1) included five patients, a robotic-assisted group (G2) included four patients, and an open group (G3) included three patients. The groups were compared in regard to operative and postoperative outcomes. RESULTS: At follow-up, all patients (one G1 patient after redo-surgery) reported complete resolution of symptoms and radiologic improvement of hydronephrosis and obstruction. In regard to postoperative complications, one G1 patient developed stenosis of anastomosis and needed re-operation with no further recurrence (IIIb Clavien). G2 reported the lowest average operative time (135 min) compared to G1 (178.3 min) and G3 (210 min). MIS (G1-G2) reported a significantly better postoperative outcome compared to open repair (G3) in terms of analgesic requirements, hospitalization, and cosmetic results. CONCLUSIONS: The study outcomes suggest that MIS should be the first choice for retrocaval ureter because of the minimal invasiveness and the better cosmetic outcome compared to open surgery. Furthermore, our results showed that robotic-assisted reconstruction was technically easier, safer, and quicker compared to laparoscopic repair, and for these reasons, it should be preferentially adopted, when available.

Retrocaval ureter: a meta-analysis of prevalence.

INTRODUCTION: Retrocaval ureter is a congenital abnormality of the right ureter, which has been shown, in rare cases to cause clinical symptoms, mainly due to the development of ureterohydronephrosis. PURPOSE: The purpose of this article is to identify the prevalence of the retrocaval ureter, and to emphasize its clinical and surgical importance. DESIGN: A meta-analysis of prevalence, on cases obtained from PubMed, Web of Science, and Scopus databases. RESULTS: A total number of 13 studies contained data that allowed us to estimate the prevalence of the retrocaval ureter, which was identified overall in 9 cases, out of 18,493 subjects. The overall prevalence of retrocaval ureter was 0.13%, with a 95% confidence interval between 0.06 and 0.27%. There was no publication bias, all studies being under the funnel. CONCLUSIONS: The overall prevalence of retrocaval ureter is 0.13%. Even if this is obviously a rare condition, its presence must be suspected by practitioners, especially in the presence of urological symptoms without a clear cause.

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.

[Ureteral Cancer Developing in Retrocaval Ureter : A Case Report].

Ureteral cancer in the retrocaval ureter is rare. We herein report a patient with this condition laparoscopically treated. A 69-year-old man was referred to us because of right ureteral cancer diagnosed during ureteroscopic surgery for a ureteral calculus. Histological diagnosis of the ureteroscopically biopsied material was non-invasive papillary urothelial carcinoma, low grade (G2). Computed tomography (CT) demonstrated a retrocaval ureter : a double J stent placed during ureteroscopy assisted the diagnosis. The patient underwent retroperitoneoscopic complete nephroureterectomy on the right side. Sufficient separation of the right ureter and the inferior vena cava under retroperitoneoscopic procedures facilitated en bloc extirpation of the kidney and ureter with a minimal lower abdominal incision. The surgical procedures for ureteral cancer in the retrocaval ureter, should be preoperatively considered with care.

Variable presentation of retrocaval ureter: Report of four cases and review of literature.

Retrocaval ureter is a rare anomaly in which the ureter passes behind the inferior vena cava due to abnormal embryogenesis. Very few cases have been reported from Africa. Although the anomaly is congenital, patients become symptomatic in the third or fourth decade of life. We reviewed the records of four patients with the diagnosis of retrocaval ureter and managed in our centre between January 2010 and December 2016. Three patients presented with recurrent colicky right flank pain while one was asymptomatic. Two patients each had Type I and Type II retrocaval ureters, respectively. Surgical repairs were achieved in the three symptomatic cases and recovery was uneventful. Retrocaval ureter, though congenital, manifests in young adults and it may be symptomatic. Pre-operative diagnosis may be difficult when the lesion is high and mimics pelviureteric junction obstruction. Thus, a high index of suspicion is required for pre-operative diagnosis. Under-reporting and asymptomatic cases may account for the low incidence.

[Laparoscopic antevasal uretero-ureteral anastomosis for treating retrocaval ureter].

The article presents a case of laparoscopic antevasal correction of the retrocaval ureter in a 16 year old patient, who was admitted to the hospital with complaints of aching pain in the right lower back. His history was noteworthy of early age onset of intermittent fever accompanied by abdominal and lumbar pain. Blood count and urinalysis were within normal limits, and he was treated symptomatically. However, no renal ultrasound scan was done. Intravenous urography and MSCT showed a retrocaval ureter. The diagnosis was confirmed by retrograde ureteropyelography. With the patient placed in the lateral position, the right ureter was mobilized by transperitoneal access, transected and mobilized from under the inferior vena cava. Anterior uretero-ureteral anastomosis on the stent was performed, drainage was established. The operating time was 90 minutes, blood loss was 60 ml. There were no postoperative complications. Drainage was removed 2 days after surgery and the patient was discharged for outpatient treatment. The stent was removed 6 weeks postoperatively. Control urography showed normal function of both kidneys, no urodynamic abnormality of the upper urinary tract was identified.

Retrocaval ureter and contra lateral renal agenesis - a case report and review of literature.

Associated congenital anomalies are seen in 21% of retrocaval ureter patients; among them, associated contralateral renal agenesis is a very rare entity. We report one such case of right circumcaval ureter with left renal agenesis, diagnosed after febrile UTI. Surgical correction with uretero-ureterostomy was successful. In literature very few such cases are reported and only one case with renal failure was reported. Unilateral renal agenesis cases complicated by associated such anomalies need definitive management and lifelong clinical monitoring to diagnose and prevent chronic kidney disease.

Surveillance of congenital malformations in infants conceived through assisted reproductive technology or other fertility treatments.

BACKGROUND: As assisted reproductive technology (ART) becomes more common, it is important to understand the associated risks. The objective of this study was to determine if congenital malformations are associated with ART or other fertility treatments in New York. METHODS: In a retrospective cohort study of all live births in upstate New York from 1997 to 2005, exposure was defined using ART or other fertility treatments as noted on birth certificates. Outcomes were assessed from the New York State Congenital Malformations Registry. Specific malformations were examined to determine if there is elevated risk for exposed singleton infants compared with infants conceived naturally. RESULTS: The study included 7120 in the ART group, 11,890 in the other fertility treatments group and 1,118,162 in the comparison group. The relative risk for a congenital malformation was 1.43 (95% CI 1.19-1.72) for singleton infants conceived through ART compared with singleton infants conceived naturally. The specific defects associated with ART were patent ductus arteriosus, hypospadias, and obstructive defect in the renal pelvis and ureter, while spina bifida, other specific anomalies of the spinal cord, atresia or stenosis of the pulmonary valve, hypospadias, and obstructive defects of the renal pelvis and ureter were associated with other fertility treatment. CONCLUSION: Assisted reproductive technology is associated with a slight excess risk of birth defects. The specific congenital malformations with elevated risks for singleton infants vary depending on the exposure. Further research is necessary to understand the mechanism related to the increase in risk.

MULTIDETECTOR-ROW COMPUTED TOMOGRAPHIC CHARACTERISTICS OF PRESUMED PREURETERAL VENA CAVA IN CATS.

Preureteral vena cava (circumcaval ureter, retrocaval ureter) occurs in a third of the feline population and has been associated with ureteral strictures in humans. The aim of this retrospective cross-sectional study was to describe the contrast-enhanced multidetector row computed tomographic (MDCT) characteristics of presumed preureteral vena cava in a group of cats. Medical records from two institutions located in different continents were searched from 2010-2013 for cases with complete contrast-enhanced MDCT examinations of the abdomen (i.e. included the entire course of the ureters and prerenal and renal segments of the caudal vena cava) and a diagnosis of preureteral caudal vena cava. For cases meeting inclusion criteria, CT scan data were retrieved and characteristics of the preureteral caudal vena cava were recorded. Presence of concomitant renal or ureteral diseases was also recorded. A total of 272 cats had contrast-enhanced abdominal CT scans during the study period and of these, 68 cats (22.43 ± 4.96%) had a diagnosis of presumed preureteral vena cava. In all affected cats, a "reverse-J ureter" was observed, i.e. a ureter running medially at the level of L4-5, passing dorsally to the caudal vena cava and then exiting ventrally between the caudal vena cava and aorta returning to its normal position. Having a preureteral vena cava resulted in an increased risk for concurrent urinary signs (OR = 3.00; CI: 95%; 1.28-6.99; P = 0.01). Findings supported the use of contrast-enhanced MDCT for characterizing morphology of preureteral vena cava and its relation with ureters in cats.

[Transperitoneal and retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter].

OBJECTIVE: To analyze the results of transperitoneal and retroperitoneal laparoscopic ureteroureterostomy procedure in the treatment of patients with retrocaval ureter. METHODS: From May 2004 to December 2012, 18 patients including 12 male and 6 female patients were operated for retrocaval ureter, the average age was (37 ± 10) years (range 17-55 years). Eight patients underwent transperitoneal laparoscopic ureteroureterostomy (transperitoneal laparoscopic group), and the other 10 patients' laparoscopic procedure were performed via retroperitoneal approach(retroperitoneal laparoscopic group). These patients' records were retrospectively analyzed for perioperative characteristics, complications and follow-up results. A two-tailed Student's t-test was used to compare perioperative data between the two groups. RESULTS: Technical success was acquired in all 18 laparoscopic procedures. Mean operative time of transperitoneal and retroperitoneal laparoscopic group was (85 ± 20) minutes (60-130 minutes) and (98 ± 30) minutes (70-180 minutes) , respectively. There was no difference in operation time between the two groups (t = 1.03, P > 0.05). The blood loss was less than 50 ml in all the patients. Comparison of anal exhaust time between the two groups showed no statistic difference (t = 0.16, P > 0.05). No perioperative complication was observed. Intravenous pyelography or CT urography 3 months after the operation revealed a widely patent anastomosis with considerable improvement in hydronephrosis in all patients. There was no recurrence at a mean follow up of (40 ± 24) months (range 12-115 months). CONCLUSION: Both transperitoneal and retroperitoneal laparoscopic ureteroureterostomy are effective and minimally invasive surgical alternative for the management of retrocaval ureter.

[Laparoscopic plastic reconstruction of retrocaval ureter].

Resection, reposition and plastic reconstruction of ureter are the main treatments for patients with retrocaval ureter. Currently, with development of endovideosurgical treatments, this operation can be successfully performed using retroperitoneal and laparoscopic approaches. The authors provide a clinical observation, which can be considered as the first successful experience of laparoscopic surgery on retrocaval ureter in our country.

Robot-assisted transperitoneal reconstruction of a retrocaval ureter: A report of two cases.

A retrocaval ureter (RCU) is a rare cause of congenital ureteral obstruction that often requires surgical repair. We report two cases of RCU in adults treated with robot-assisted laparoscopic surgery. In both cases, we performed robotic ureteroureterostomy with dissection of the entire length of the retrocaval portion of the right ureter without complications. In the second case, renal stone removal was simultaneously performed. The robot-assisted procedure we performed could be considered safe and feasible for the surgical repair of an RCU.

Congenital venous anomalies associated with retrocaval ureter: evaluation using computed tomography.

BACKGROUND: Retrocaval ureter is a rare congenital anomaly resulting from anomalous development of inferior vena cava (IVC) and not from anomalous of the ureter. The anomaly always occurs on the right side due to regression of right supracardinal vein and persistence of right posterior cardinal vein. Retrocaval ureter tends to be associated with various vena cava anomalies because of the embryogenesis. We aimed to identify the prevalence of associated congenital venous anomalies (CVA) resulting from cardinal vein development in adults with retrocaval ureter using computed tomography (CT) images. MATERIALS AND METHODS: The study included 22 adults with retrocaval ureter. We evaluated CT findings and determined the incidence of associated CVA using thin slice data sets from CT scanner with 64 or more detectors. We compared the prevalence of CVA in the retrocaval ureter group (mean age: 57 ± 19 years) and in the control group of 6189 adults with normal ureter (mean age: 66 ± 14 years). RESULTS: In the retrocaval ureter group, 4 (18.2%) adults had CVA including double IVC, right double IVC, preisthmic IVC with horseshoe kidney, and preaortic iliac confluence. One of 2 adults with preaortic iliac confluence had right double right IVC. In the control group, 49 (0.79%) adults had CVA including 37 double IVC, 11 left IVC, and 1 IVC interruption azygos continuation. Fifteen horseshow kidneys were found. The prevalence of associated CVA in the retrocaval ureter group was higher than that in the control group (p < 0.001). CONCLUSIONS: Retrocaval ureter is frequently associated with CVA. Various CVA with retrocaval ureter could happen because of abnormal development of not only the right posterior or supra cardinal vein but also other cardinal veins.

Transperitoneal laparoscopic ureteropyeloplasty of retrocaval ureter: Single surgeon experience and review of literature.

INTRODUCTION: Retrocaval ureter (RCU) is a rare congenital abnormality, secondary to anomalous development of inferior vena cava (IVC) presenting as ipsilateral obstruction needing surgical intervention. The aim of this article is to present surgical techniques and outcome of transperitoneal laparoscopic ureteropyeloplasty in patients with RCU treated by a single surgeon at a tertiary care center and with review of literature. MATERIAL AND METHODS: We conducted a retrospective, institutional review board approved chart review of patients who underwent transperitoneal laparoscopic ureteropyeloplasty for RCU at our unit between January 2010 and December 2020. A total of 10 patients were identified. Preoperative evaluation involved a computed tomography-intravenous urography in addition to the conventional evaluation. All the patients underwent dismembered transperitoneal laparoscopic ureteropyeloplasty over a Double J stent. Data analyzed included the demographic profile, operative time difficulty if any, postoperative, intraoperative complications and functional outcome. RESULTS: All cases were completed laparoscopically and no open conversion was required. Average operating time was 96.6 minutes ± 8.16. Average blood loss was 71 ± 14.49 mL with an analgesia requirement of 115 ± 33.74 mg. One patient developed postoperative urinary leak and responded to percutaneous nephrostomy drainage. Patients were followed up for 3 to 12 months with a serial ultrasound and a follow-up diethylene-triamine-penta-acetic acid renal scan at 3 months to rule out any anastomotic site obstruction. CONCLUSION: Transperitoneal laparoscopic ureteropyeloplasty for RCU was associated with minimal morbidity and good outcomes.

Computed tomographic appearance of circumcaval and circumuterine ureter in a cat.

BACKGROUND: Circumcaval ureter is a rare congenital anomaly resulting from the persistence of embryonic venous system. This anomaly is characterized by running of affected ureter around caudal vena cava (CVC). CASE PRESENTATION: In this report, circumcaval ureter was found in a 2-year-old female cat attending as normal sample group in another research. This cat passed all health checkup protocols before computed tomography (CT) was performed. CONCLUSION: The contrast-enhanced computed tomographic (cCT) images clearly revealed the dislocation of the right ureter that course around CVC and uterine body. This is the first report of feline circumcaval concurrent with circumuterine ureter detected by cCT.

Percutaneous nephrolithotomy and retroperitoneal laparoscopy in treatment of retrocaval ureter with right renal and ureteral calculi: a case report.

Retrocaval ureter is a rare disease associated with abnormal embryonic development. Here, we describe a patient who exhibited retrocaval ureter complicated by renal and ureteral calculi, which were treated by percutaneous nephrolithotomy combined with retroperitoneal laparoscopy. A 64-year-old man was admitted to our hospital because of intermittent back pain that had been present for more than 10 years. During hospitalization, he was diagnosed with retrocaval ureter, right renal calculi, and right ureteral calculi with right hydronephrosis; he underwent percutaneous nephrolithotomy combined with retroperitoneal laparoscopic surgery. After the operation, his condition was stable and he exhibited good recovery. Our findings in this case suggest that percutaneous nephrolithotomy combined with retroperitoneal laparoscopy is a suitable option for the treatment of retrocaval ureter with renal and ureteral calculi.