Laparoscopic repair of retro-caval ureter: report of two cases

Retrocaval ureter is a rare congenital disorder and surgery is necessary when the patient is symptomatic or having significant functional obstructions. The two cases referred to our center with severe hydronephrosis on their right sides. In both cases further evaluation with CT scan showed the diagnosis of retrocaval ureter. The retrocaval segment of the both ureters were isolated and after the excision of the narrow segments, end to end anastomosis have been done with transperitoneal laparoscopic technique. The laparoscopic ureteroureterostomy is a safe, effective and minimally invasive procedure and should be considered as a standard treatment for retrocaval ureter.

Prevalence of Congenital Anomalies of the Inferior Vena Cava: CT Assessment in Thai Patients

Objective: To determine the prevalence of inferior vena cava (IVC) anomalies in Thai patients who underwent contrast-enhanced computed tomography (CT) of the abdomen. Materials and Methods: Two radiologists retrospectively and independently reviewed the contrast-enhanced abdominal CT examinations in 1,429 Thai patients between August 1, 2018 and January 25, 2019 who met the inclusion criteria. Patients were included, if (a) their CT showed well visualized IVC, renal veins, and right ureter that were not obliterated by tumor, cyst, fluid collection, or intraperitoneal free fluid, (b) they had not undergone previous abdominal surgery that altered anatomical configuration of the IVC, renal veins, and right ureter. The presence of all IVC anomalies were recorded. Results: Among the 1,429 studied patients, 678 were male (47.4%) and 751 were female (52.6%). The prevalence of IVC anomalies was 3.5%. Five types of IVC anomalies were presented. The most common was circumaortic left renal vein in 24 patients or 48.0% of all IVC anomalies and 1.7% of the study population, followed by retroaortic left renal vein in 15 patients or 30.0 % of all IVC anomalies and 1.0% of the study population. Other IVC anomalies included double IVC, left IVC, and retrocaval ureter at 0.5%, 0.2%, and 0.1% of the study population, respectively. Conclusion: The prevalence of IVC anomalies in the present study differed from the previous studies conducted in other countries, which may be attributable to differences in race and ethnicity. Awareness of these anomalies is essential when evaluating routine CT examinations in asymptomatic patients. Their presence should be carefully noted in radiology reports to avoid anomaly-related complications. Keywords: Prevalence; IVC anomalies; Circumaortic left renal vein; Retroaortic left renal vein; Double IVC; Left IVC; Retrocaval ureter

Retrocaval Ureter (Pre-Ureteral Vena Cava) – Rare Cause Of Hydroureteronephrosis, An Interesting Case Report

RETROCAVAL URETER (or PRE-URETERAL VENA CAVA) is a rare congenital abnormality arising from dysgenesis of the inferior vena cava (IVC) that results in the right ureter coursing posterior and medial to the inferior vena cava (IVC), causing varying degrees of obstructive proximal hydroureteronephrosis, a rare cause of long-standing cyclical flank pain. Retrocaval ureter (or Pre-ureteral vena cava) is asymptomatic until the 3rd and 4th decades of life from resulting hydronephrosis. Ultrasonography (USG), Intravenous urography (IVU), nuclear scintigraphy, Computed tomography urography (CTU), and Magnetic resonance urography (MRU) have been used in the diagnosis of this abnormality. Computed tomography urography (CTU) depicts the findings in three dimensions gives the most “wholesome” solution to its diagnosis. This condition is differentiated from other urinary tract obstruction causes, especially urolithiasis, essential for successful surgical management. When symptomatic, the situation is treated surgically, either by laparoscopic or open surgery. We report a case of a 50 years old male both with right flank pain and associated hydronephrosis.

Exteriorização de material cirúrgico em luz esofageana / Exteriorization of surgical material in esophagus lumen

Introdução: O ureter retrocava é uma malformação congênita rara que pode ser causa de uropatia obstrutiva com sintomas inespecíficos como dor lombar e complicações como ureterolitíase e pielonefrite, que normalmente aparecem entre a terceira e a quarta décadas de vida, e exige tratamento cirúrgico na maior parte dos casos. Objetivo: Apresentar um caso de ureter retrocava associado a ureterolitíase e uma revisão da literatura a respeito das técnicas cirúrgicas para sua correção. Relato de caso: Os autores apresentam um caso de ureterolitíase e ureter retrocava, diagnosticado por tomografia computadorizada, em um paciente masculino de 43 anos com dor lombar direita, corrigido através de técnica laparoscópica transperitoneal. Conclusão: A correção cirúrgica laparoscópica do ureter retrocava tem se mostrado benéfica em diversos aspectos quando comparada ao acesso aberto e uma abordagem que ainda não havia sido publicada é a correção do ureter retrocava associado a ureterolitíase num mesmo tempo cirúrgico.Palavras chave: Ureter retrocava, Hidronefrose, Ureterolitíase, Anomalia urogenital, LaparoscopiaABSTRACTIntroduction: The retrocaval ureter is a rare congenital malformation which may cause obstructive uropathy with nonspecific symptoms such as low back pain and complications as ureterolithiasis and pyelonephritis, which usually appear between the third and fourth decades of life, and requires surgical treatment in most cases. Objective: To present a case of ureterolithiasis and retrocaval ureter and a review of literature, regarding the different types of access for his surgery. Case Report: The authors present a case of ureterolithiasis and retrocaval ureter diagnosed by computed tomography in a 43-year-old male patient with right lower back pain, corrected using a transperitoneal laparoscopic technique. Conclusion: Laparoscopic surgical correction of the retrocaval ureter has shown to be beneficial in several aspects when compared to open access, and one that has not been previously reported is the one-step resolution of the association with ureterolithiasis.Keywords: Retrocaval ureter, Hydronephrosis, Ureterothiasis, Urogenital abnormalities, Laparoscopy

Tratamento laparoscópico de cálculo ureteral em ureter retrocava / Laparoscopic treatment of ureteral stone in retrocaval ureter

Introdução: O ureter retrocava é uma malformação congênita rara que pode ser causa de uropatia obstrutiva com sintomas inespecíficos como dor lombar e complicações como ureterolitíase e pielonefrite, que normalmente aparecem entre a terceira e a quarta décadas de vida, e exige tratamento cirúrgico na maior parte dos casos. Objetivo: Apresentar um caso de ureter retrocava associado a ureterolitíase e uma revisão da literatura a respeito das técnicas cirúrgicas para sua correção. Relato de caso: Os autores apresentam um caso de ureterolitíase e ureter retrocava, diagnosticado por tomografia computadorizada, em um paciente masculino de 43 anos com dor lombar direita, corrigido através de técnica laparoscópica transperitoneal. Conclusão: A correção cirúrgica laparoscópica do ureter retrocava tem se mostrado benéfica em diversos aspectos quando comparada ao acesso aberto e uma abordagem que ainda não havia sido publicada é a correção do ureter retrocava associado a ureterolitíase num mesmo tempo cirúrgico. Palavras chave: Ureter retrocava, Hidronefrose, Ureterolitíase, Anomalia urogenital, Laparoscopia ABSTRACT:Introduction: The retrocaval ureter is a rare congenital malformation which may cause obstructive uropathy with nonspecific symptoms such as low back pain and complications as ureterolithiasis and pyelonephritis, which usually appear between the third and fourth decades of life, and requires surgical treatment in most cases. Objective: To present a case of ureterolithiasis and retrocaval ureter and a review of literature, regarding the different types of access for his surgery. Case Report: The authors present a case of ureterolithiasis and retrocaval ureter diagnosed by computed tomography in a 43-year-old male patient with right lower back pain, corrected using a transperitoneal laparoscopic technique. Conclusion: Laparoscopic surgical correction of the retrocaval ureter has shown to be beneficial in several aspects when compared to open access, and one that has not been previously reported is the one-step resolution of the association with ureterolithiasis.Keywords: Retrocaval ureter, Hydronephrosis, Ureterothiasis, Urogenital abnormalities, Laparoscopy