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(a) Right side retrocaval ureter on IVP and (b) 3D computed tomography (CT) scan reconstruction with the typical S-shaped deformity.
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Context 1
... patients who underwent retroperitoneoscopic ureteroureterostomy for retrocaval ureter in the Department of Urology of Chinese PLA General Hospital from April 2002 to September 2013. Data's were collected during a fellowship experience. All patients were counselled about the risks, benefits and alternative treatments for the condition; individual informed consent was obtained for this cohort. Preoperative evaluation, including medical history, physical examination and laboratory tests, was performed in all patients. All patients were evaluated preoperatively with renal ultrasonography, intravenous pyelography (IVP), and Contrast-enhanced Computed Tomography (CT) scan. The grading system for classification of hydronephrosis was used [9,10]. The Bateson and Atkinson Classification were used for recognising the type of retrocaval ureters [5]. Diagnosis of retrocaval ureter was made on IVP and/ or retrograde pyelography and Contrast-enhanced CT scan, by demonstrating a typical S-shaped or sickle shaped deformity of the ureter associated with a moderate hydronephrosis and a dilated proximal ureter (Figure 1). Follow-up consisted in a clinical visit associated with renal ultrasound at 1 month and then in a clinical visit associated with Contrast-enhanced CT scan and renal ultrasound at 3, 6 and 12 months,. In case of a favorableevolution (symptom-free and significantdecrease of dilatation), follow-up (clinicalvisit and Contrast-enhanced CT scan) wasdoneannually for 5 ...
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Duplex collecting systems are the most commonly encountered anomaly of the urinary system. Complete duplex system with an H shaped ureter is a very rare situation. There are only two reported H ureter cases in the literature. Herein, we aimed to present an H shaped ureter case, which was identified while performing ureterorenoscopy to a 48-year-old...
Citations
... Patients who are treated generally have an uneventful course and an excellent prognosis, as observed in our cases. Ricciardulli et al., 21 have described vast experience of retroperitoneal laparoscopic approach in 27 cases of RCU. In this, operative time is reduced as there is no need for colon mobilization and liver retraction. ...
Background: Retrocaval ureter (RCU) is a rare congenital anomaly. It occurs due to anomalous development of inferior vena cava (IVC) and not ureter. Here, we describe our experience in surgical techniques and operative results of laparoscopic reconstruction for patients with RCU.
Aims and Objectives: The aims of this study were to obtain information regarding clinical presentation, demographic profiles, investigations, indications for intervention, postoperative complications of laparoscopic repair of retrocaval repair, and also to develop laparoscopic surgical skill without causing any untoward effects to the patients.
Materials and Methods: Twelve patients with RCU were enrolled in this study. The mean age was 32.4-years-old (23–37 years). All patients were preoperatively evaluated with different relevant imaging modalities. Laparoscopic surgery with transperitoneal approach with insertion of double-j stent was performed to all patients by same surgeon without excision of compressed ureter. Post-operative follow-up was done with ultrasonography every 3 months and repeat DTPA renogram every 6 months for 2.4 years.
Results: All operations were completed laparoscopically without conversion to open surgery. There was no obstruction or symptom after the mean follow-up of 2.4 years.
Conclusion: Transperitoneal laparoscopic repair is a feasible, safe, and effective modality of The treatment for RCU. Careful dissection along the planes with good respect to tissue and proper hemostasis during each step is the key to success for laparoscopic repair of RCU.
... They also stated that with preserving the ureter, anostomosis can be done without high tension. But according to another study, the ureter just behind the vena cava is usually atretic and therefore should be excised 9 . They also stated that tension free anostomosis is mandatory. ...
Retrocaval ureter is a rare congenital anomaly that can cause hydroureteronephrosis. The right ureter winds posterior to the inferior
vena cava and then continues to cours anteriorly due to abnormal embryogenesis of vena cava. Retrocaval ureter is seen mostly on
the right side except patients with situs inversus. Although retrocaval ureter is a congenital disease, patients become symptomatic
during the third or fourth decade of their lives. Flank pain, hematuria, upper tract urinary infections and urolithiasis are the symptoms
can be seen. Ultrasound can show the dilation of the kidney but it is far from accurate diagnosis. Retrocaval ureter is diagnosed with
intravenous pyelography (IVP), computed tomography urography (CTU) and magnetic resonance urography (MRU). Mild
hydronephrosis with good excretory times can be followed without surgical intervention. But severe hydronephrosis with symptoms
should be corrected with surgery. The surgical treatment involves excision of the retrocaval part of the ureter then bringing it anterior
to the vena cava followed by ureteroureteral or ureteropelvic anastomosis. Open, laparoscopic and robotic surgeries are the different
treatment modalities. Transperitoneal and retroperitoneal approaches are different options for the surgery. In this paper we report a
retrocaval ureter case managed with laparoscopic ureteroureterostomy.
... For example, de Carlo, by reviewing all the cases published before him, found a male:female ratio of 17:6 [4]. Other authors give a ratio around 2.8 [25]. However, as de Carlo pointed out, this ratio could be caused by the increased number of men who were autopsied at the time [4], or a gender-based difference in addressability to physicians. ...
... The main advantages of the transperitoneal laparoscopic approach include more working space, ease of transperitoneal suturing, decreased hemorrhage risk; more urologists are familiar with this approach, urine leak can be contained easier [8,31]. The main advantages of the retroperitoneal laparoscopic approach include a decreased operating time (no need for mobilizing the colon or retracting the liver), and an easier access to the urinary tract [25]. ...
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.
... ml estimated blood loss, a median 2 (2-3) days drain removing time and a median 3 (2-4) days hospital stay are consistent with the literature shown in Tables 2-4. [8,9,[23][24][25][26][27][28][29][30][31][32][33][34] We did not found significant differences regarding estimated blood loss, drain removal time and hospital stay between the laparoscopic and robotic repair of RCU, in the present study. However, the mean operative time was significantly shorter (92 ± 48.27 vs. 190 ± 46.36 min) with the robotic approach without any complications. ...
Background:
The use of minimally invasive surgical approaches for the repair of retrocaval ureter (RCU) has been increased in time. However, the results of the robotic approach have not yet been compared with those of open or laparoscopic approaches. We aimed to compare the results of laparoscopic and robotic transperitoneal repair of RCU from two centres.
Patients and methods:
Initially, we performed a systemic literature search using MEDLINE/PubMed and Google Scholar about the RCU. Finally, a comparison of the efficacy and outcomes of the laparoscopic and robotic transperitoneal approaches for RCU repair was performed with the results of two centers.
Results:
The mean age was 27.5 ± 3.6 years. The mean operative time was 147 ± 63.6 min. The median estimated blood loss was 100 (20-423.9) ml. The median drain removing time and hospital stay were 2 (2-3) and 3 (2-4) days, respectively. The mean follow-up period was 17.85 ± 14.6 months. All of the parameters were similar between the laparoscopic and robotic repair groups except for the mean operative time. It was significantly shorter in robotic repair group than those of laparoscopic repair group (P = 0.02). Furthermore, a ureteral stricture of the anastomotic segment was detected in a patient treated with laparoscopy during the follow-up.
Conclusions:
Robotic transperitoneal approach may shorten the operative time enabling a greater comfort in repair of RCU.
... One can get early access to urinary tract. They have mean operative time of 131 min in 27 cases [24] . Ji et al. analyzed results of 10 retroperitoneal and 8 transperitoneal laparoscopic RCU repairs from the same center. ...
... All approaches have pros and cons with respect to each other. Ricciardulli et al. [7] have described vast experience of retroperitoneal laparoscopic approach in 27 cases of RCU. In this, operative time is reduced as there is no need for colon mobilization and liver retraction. ...
Context and Aim: Retrocaval ureter (RCU), also known as circumcaval ureter, occurs due to anomalous development of inferior vena cava (IVC) and not ureter. The surgical approach for this entity has shifted from open to laparoscopic and robotic surgery. This is a relatively new line of management with very few case reports. Herein, we describe the etiopathology, our experience with six cases of transperitoneal laparoscopic repair of RCU operated at tertiary care center in India and have reviewed different management options.
Methods: From 2013 to 2016, we operated total six cases of transperitoneal laparoscopic repair of RCU. All were male patients with average age of 29.6 years (14–50). Pain was their only complaint with normal renal function and no complications. After diagnosis with CT Urography, they underwent radionuclide scan and were operated on. Postoperative follow-up was done with ultrasonography every 3 months and repeat radionuclide scan at 6 months. The maximum follow-up was for 2.5 years.
Results: All cases were completed laparoscopically. Average operating time was 163.2 min. Blood loss varied from 50 to 100 cc. Ureteroureterostomy was done in all patients. None developed urinary leak or recurrent obstruction postoperatively. Maximum time for the requirement of external drainage was for 4 days (2-4 days). Average postoperative time for hospitalization was 3.8 days. Follow-up ultrasound and renal scan showed unobstructed drainage.
Conclusions: Transperitoneal or retroperitoneal approach can be considered equivalent as parameters like operative time, results are comparable for these two modalities. We preferred transperitoneal approach as it provides good working space for intracorporeal suturing.
Retrocaval ureter also referred to as pre-ureteral vena cava or circumcaval ureter is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava. Although it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life after a resulting hydronephrosis. We present the report of a 12-year-old male child with a history of right flank pain and associated right proximal hydroureteronephrosis. Diagnosis was confirmed with computerized tomography urography, and an open surgical repair was done for the anomaly. The case is discussed here along with review of recent literature.