Page 33 - World Journal of Laparoscopic Surgery

Retrocaval Ureter

Fig. 3: Stone being retreived through rigid nephroscope Fig. 4: Pyeloureterostomy being performed

dIscussIon Table 2: Results
Retrocaval ureter is a rare congenital anomaly and is also termed Number of patients 5
7,8
circumcaval ureter. The proposed cause of this anomaly is that Age (years) 33 (19–45)
there is the persistence of the subcardinal vein as the infrarenal IVC,
thus crossing anterior to the ureter in its midportion and resulting Operative time (minute) 115 (90–130)
9
in its circumcaval course. It most commonly occurs on the right Intraoperative blood loss (mL) 50 (45–80)
ureter, and if it occurs on the left ureter, then it is usually associated
with a duplicated IVC or situs inversus. 10,11 Retrocaval ureter Hospitalization (days) 2.2 (2–4)
may be identified incidentally on radiological imaging for some Complications (modified Clavien– One patient: Grade III:
12
other problems and can be asymptomatic. Contrast-enhanced Dindo) Port-site incisional hernia)
computed tomography scan of the abdomen is the investigation
13
of choice for the retrocaval ureter. In symptomatic patients ureter and associated renal calculi, if the renal scan is suggestive
with documented renal functional obstruction, dismembered of obstructed drainage and management of only calculi is not
pyeloplasty or ureteroureterostomy or pyeloureterostomy, with sufficient, simultaneous management of both the entities should
or without the excision of the diseased segment, is the gold be considered in the same sitting.
standard treatment. 14,15 Baba et al. reported the first case of
managing a circumcaval ureter laparoscopically by performing a
16
transperitoneal dismembered pyeloplasty. Surgical management references
17
is reserved for type I cases that are usually symptomatic. Patients 1. Heslin JE, Mamonas C. Retrocaval ureter: report of four cases and
who are asymptomatic and have minimal calyceal dilation do not review of literature. J Urol 1951;65(2):212–222. DOI: 10.1016/s0022-
require surgical intervention although they should be followed up 5347(17)68477-5.
carefully. 17,18 Few reports are mentioned in the literature describing 2. Lutin EM, Haramati N, Frager D, et al. CT diagnosis of circumcaval
ureter. AJR Am J Roentgenol 1988;150(3):591–594. DOI: 10.2214/
the simultaneous association of retrocaval ureter and renal calculi ajr.150.3.591.
and their management. Simultaneous treatment of renal stone and 3. Olson RO, Austen G Jr. Postcaval ureter; report and discussion of a
retrocaval ureter with laparoscopic technique has been reported case with successful surgical repair. N Engl J Med 1950;242:963–968.
19
by Simforoosh et al. Mugiya et al. in their case report described DOI: 10.1056/NEJM195006222422501.
that simultaneous management of retrocaval ureter and upper 4. Bateson EM, Atkinson D. Circumcaval ureter: a new classification.
20
ureteric calculus was done during the same procedure. Similarly, Clin Radiol 1969;20(2):173–177. DOI: 10.1016/s0009-9260(69)80166-2.
Singh et al. also managed a case of retrocaval ureter and renal stone 5. Kenawi MM, Williams DI. Circumcaval ureter. A case report of four
by simultaneously performing a dismembered pyeloplasty and cases in children with a review of literature and new classification.
Br J Urol 1976;48(3):183–192. DOI: 10.1111/j.1464-410x.1976.tb10197.x.
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pyelolithotomy. Our experience of simultaneous management 6. Zhang XD, Hou SK, Zhu JH, et al. Diagnosis and treatment of retrocaval
of retrocaval ureter and stone is perhaps the largest to date. ureter. Eur Urol 1990;18:207–210. DOI: 10.1159/000463911.
We managed five such cases using both the laparoscopic and 7. Dreyfuss W. Anomaly simulating a retrocaval ureter. J Urol
endourology armamentarium with minimal complications (Tables 1 1959;82:630–632. DOI: 10.1016/s0022-5347(17)65947-0.
and 2). So, to conclude, a transperitoneal laparoscopic approach is 8. Lerman I, Lerman S, Lerman F. Retrocaval ureter: report of a case.
a good treatment option for managing both the retrocaval ureter J Med Soc N J 1956;53:74–77. PMID: 13286686.
and the associated stone disease. One of the reasons is that the 9. Schulman CC. The ureter. In: O’Donnell B, Koff SA, editors. Pediatric
transperitoneal approach gives one more freedom to maneuver urology. 3rd ed. Oxford: Butterworth-Heinemann; 1977. p. 409–410.
the endoscopic instruments and also the accumulated irrigation 10. Watanabe M, Kawamura S, Nakada T, et al. Left preureteral vena
cava (retrocaval or circumcaval ureter) associated with partial
fluid does not hinder the vision much. This could be a problem situs inversus. J Urol 1991;145(5):1047–1048. DOI: 10.1016/s0022-
with the retroperitoneal approach. In the presence of retrocaval 5347(17)38528-2.

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