Treatment of retrocaval ureter by retroperitoneal laparoscopic ureteroureterostomy: experience on 12 patients.

摘要

OBJECTIVE: To present our experience and the feasibility of retroperitoneal laparoscopic ureteroureterostomy (LUUS) for treatment of retrocaval ureter (RCU). PATIENTS AND METHODS: A total of 12 patients with RCU underwent LUUS. To evaluate the retrocaval segment, we calibrated retrocaval segment by a number 8F catheter segment before laparoscopy. A three-port, finger-dissecting removal of the retroperitoneal fat, retroperitoneal approach was used. In all 12 cases, after the ureter had been released from the inferior vena cava (IVC), the ureter was transected at the lower part of the dilated ureter and positioned anterior to the IVC. A tension-free ureteroureteral anastomosis was completed with the intracorporal freehand suturing techniques. Follow-up studies were performed with intravenous urography and renal ultrasonography at 3 and 6 months postoperatively. RESULTS: All operations were laparoscopically completed with no open conversion. The mean operating time was 112 minutes (range 89-158), and the mean anastomosis time was 42 minutes, for all cases. The mean blood loss was 35 mL (range 21-60). The retrocaval segments of the ureter were resected in 2 of 12 cases, because the 8F catheter could not negotiate the segment. No intraoperative complications occurred. Hydronephrosis in all patients was decreased substantially after surgery, and all patients were symptom free. CONCLUSION: Our results have demonstrated that retroperitoneal LUUS was a safe and effective procedure, and an excellent minimally invasive treatment option for RCU.