Treatment of retrocaval ureter by pure laparoscopic pyelopyelostomy: experience on 4 patients.

OBJECTIVES: To present our experience and the feasibility of pure laparoscopic pyelopyelostomy for treatment of retrocaval ureter (RCU).

METHODS: RCU was detected in 4 male (ages: 4, 16, 36, 48) patients, with complaints of flank pain. In all the patients, Type 1 RCU was present and the right ureter was involved. All patients underwent intraoperative retrograde pyelography before laparoscopy. The patients were operated upon using the transperitoneal approach in the lateral decubitis position, with two 10 mm and two 5 mm ports. After the ureter was released from the superior and inferior parts of the inferior vena cava, the dilated renal pelvis was transected and the ureter was brought in an anterolateral position to the vena cava. After the completion of the posterior wall anastomosis of pyelopyelostomy with 4-0 polyglactin sutures in a continuous manner, a double-J-stent was placed and the anterior wall was anastomosed in a watertight manner. A drain was placed in the operative area and the operation was completed.

RESULTS: Mean operation time was 210 minutes. No intraoperative complications occurred. In one patient, antegrade double-J-stent placement failed, and the stent was therefore placed in the retrograde way without any complications. Postsurgery, the urethral catheter was removed on the first day, and the drain on the second. All patients were discharged 48 hours after surgery. The third month postoperative follow-up confirmed that the anastomoses were patent and patients were symptom-free.

CONCLUSIONS: Pure laparoscopic pyelopyelostomy seems technically feasible and reliable for RCU treatment. Our experience showed that laparoscopy should be the standard treatment option for such patients.