Page 31 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Simultaneous Management of Retrocaval Ureter with

Ipsilateral Renal Stone Disease: Single Center Experience

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Chandrakant Munjewar , Priyanka Rai , Amarjot Singh , Sanjeet Singh , Sanjay Bhatt , Alok Srivastava 6
AbstrAct
Aim: To report our experience in managing retrocaval ureter and ipsilateral renal stone disease.
Materials and methods: Till now we have managed five such cases. Physical examination and laboratory investigations were unremarkable in
all patients. Ultrasonography revealed right moderate hydronephrosis and a single upper calyceal stone in two, inferior calyceal calculus in two,
and a pelvic calculus in one patient. A CT urography and Tc-99m diethylene-triamine-penta-acetic acid (DTPA) scan were done in all patients.
In all patients, the renal scan was suggestive of reduced function with a right obstructed drainage pattern.
Results: All patients were managed successfully by a combined laparoscopic and endourological approach. No intraoperative or major
postoperative complications were noted. On follow-up renal scan done at 1 year, all patients had unobstructed drainage and improved or
stable split function.
Conclusion: Combined laparoscopic and endourologic approach is the adequate modality of treatment of patients with obstructed retrocaval
ureter with ipsilateral renal calculi.
Keywords: Laparoscopy, Retrocaval ureter, Stone disease.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1504

IntroductIon 1 Department of Urology, Sagar Shree Hospital and Research Institute,
Retrocaval ureter is a rare congenital anomaly of the upper urinary Sagar, Madhya Pradesh, India
tract. It is more common in males with 2.8-fold male predominance 2,3,5 Department of General Surgery, Dr Ram Manohar Lohia Institute of
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with a reported incidence of approximately 1 in 1,100. It was Medical Sciences, Lucknow, Uttar Pradesh, India
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first observed and reported by Hochstetter in 1893. It usually 4,6 Department of Urology and Renal Transplantation, Dr Ram Manohar
presents with symptoms in the third and fourth decades of life, Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
due to obstruction leading to hydronephrosis. Hydronephrosis Corresponding Author: Alok Srivastava, Department of Urology and
may be a result of pressure on the ureter at the kinked site, an Renal Transplantation, Dr Ram Manohar Lohia Institute of Medical
adynamic segment, or compression on the retrocaval part against Sciences, Lucknow, Uttar Pradesh, India, Phone: +91-9935699433,
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the psoas muscle. The course of the retrocaval ureter is variable e-mail: dralokpriyanka@gmail.com
and is classified on intravenous urography as type I having How to cite this article: Munjewar C, Rai P, Singh A, et al. Simultaneous
S-shaped, fish hook or J-shaped or type II having sickle-shaped Management of Retrocaval Ureter with Ipsilateral Renal Stone Disease:
retrocaval course, a lesser common form and associated with a Single Center Experience. World J Lap Surg 2022;15(2):127–130.
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mild degree of hyderonephrosis. The usual management in Source of support: Nil
symptomatic individuals is mobilization of the ureter all along Conflict of interest: None
its course usually till the pelvic brim including the retrocaval part
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and then performing a ureteroureterostomy. In patients with a
retrocaval ureter along with the presence of renal calculi, it is a most common presenting feature. It was intermittent in nature and
clinical dilemma whether to treat the renal calculus alone or to treat relieved by analgesics. One male and one female had a history of
the ureteral obstruction also. There is a paucity of the literature recurrent episodes of a UTI. There was no significant finding on
describing simultaneous laparoscopic/endoscopic management clinical examination of the abdomen. Blood investigations including
of renal calculi in the presence of a retrocaval ureter. Till now we renal function test, general blood picture, and electrolytes were
have managed five cases of the obstructed retrocaval ureter with within normal limits. Ultrasonography, CT urography, and diuretic
ipsilateral renal stone disease. We are discussing our cases of the renal scan (Tc-99m diethylene-triamine-penta-acetic acid, DTPA)
retrocaval ureter (type I) with obstructive drainage and renal calculi were done for all patients (Table 1).
which were successfully managed with the combined endoscopic
and laparoscopic approach. operAtIve technIque
Informed consent was taken by all patients. Cystoscopy and right
MAterIAls And Methods retrograde pyelography were performed, which showed findings
Between August 2012 and January 2020, five patients (three males suggestive of the right retrocaval ureter. A 6-F ureteric catheter was
and two females) were operated on for type I retrocaval ureter negotiated in the right ureter and with some difficulty, it could be
with obstructive drainage and renal calculi. The median age of negotiated till the right renal pelvis. In one of the patients who had
patients was 38 years (19–45 years). Pain in the right flank was the a 2.2 cm inferior calyceal stone, percutaneous nephrolithotomy

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