Laparoscopic Repair of Retrocaval Ureter with Pyelopyelostomy Technique: Our Early Experience of 4 Patients

Retrocaval ureter is a rare congenital abnormality. Surgical repair would be necessary in the setting of functional or anatomic stenosis. Various techniques for laparoscopic repair of RCU were reported recently. The aim of present study is to describe our experience and techniques during laparoscopic pyelopyelostomy, as a new challenging technique, for Retrocaval ureter in 4 cases. One woman and three men with the mean age of 36.5 years (range 16 to 48) referred to our department with the diagnosis of Retrocaval ureter. With transperitoneal laparoscopic approach, dilated renal pelvis was mobilized and transected at distal portion; ureter was replaced anterior to inferior vena cava. Patency of the retrocaval segment was confirmed by passing a 10Fr Nelaton catheter. Pyelo-pyelostomy was performed in running manner with intracorporeal suturing, over an antegrade inserted Double-J stent that was removed 4 weeks later. Follow up intravenous urography was performed 3 and 12 months after operation. Mean operative time was 105 minutes (range 90 to 120). Recovery was uneventful in all patients. Follow up intravenous urography revealed patent anastomosis without stenosis and also significant improvement in hydronephrosis that accompanied by complete resolution of patient’s symptoms. Laparoscopic pyelo-pyelostomy without excision of retrocaval segment is a safe, reliable and less time-consuming technique in management of Retrocaval ureter and can be the procedure of choice if retrocaval segment is not grossly stenotic.