Retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter: report of 10 cases and literature review.

ABSTRACT

OBJECTIVES: To present our surgical techniques and experience with retroperitoneal laparoscopic ureteroureterostomy in 10 patients with retrocaval ureter and review the data on the laparoscopic management of retrocaval ureter published in English. METHODS: A total of 10 patients with retrocaval ureter underwent laparoscopic ureteroureterostomy. A 3-port, finger and balloon-dissecting, retroperitoneal approach was used. The retrocaval segment of ureter was mobilized and transposed anterior to the inferior vena cava. The ureteroureteral anastomosis was completed with the intracorporal freehand suturing and in situ knot tying techniques. Intravenous pyelography was performed 3 and 6 months, postoperatively. Thereafter, intravenous pyelography follow-up was then continued at 12-month intervals for 3 years, and yearly renal ultrasonography follow-up was continued for at least 2 years. A comprehensive electronic English-language literature search of PUBMED was conducted. RESULTS: All operations were completed laparoscopically without conversion to open surgery. The mean operative time was 82 minutes (range, 60-110 minutes). The blood loss was minimal (< 10 mL). No perioperative complication occurred. All patients achieved an uneventful recovery. At a mean follow-up of 52 months, remarkable improvement in the ureteral obstruction was observed. Data of 19 patients in 12 published English-language literatures were reviewed. CONCLUSIONS: Our results indicate that retroperitoneal laparoscopic ureteroureterostomy is a safe and effective procedure, and an excellent minimally invasive treatment option for retrocaval ureter. Moreover, a thorough review of published data supports our viewpoint that laparoscopic surgery should probably be the first-line treatment for retrocaval ureter.