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Wang X, Zhang Y, Li Z, Li X, Chen S, Han G, Xia M, Yang K, Zhou L, Zhang K, Li X. Robot-assisted laparoscopic ureteroplasty for retrocaval ureter with three-dimensional images navigation: technique and outcomes. BJU Int 2024; 133:622-627. [PMID: 38269753 DOI: 10.1111/bju.16278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Xiang Wang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Yiming Zhang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
- Department of Nursing, Peking University First Hospital, Peking University, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Mancheng Xia
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China
- Institution of Urology, Peking University, Beijing, China
- Beijing Key Laboratory of Urogenital Diseases (Male) Molecular Diagnosis and Treatment Center, Beijing, China
- National Urological Cancer Center, Beijing, China
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Alwadai R, Alqarni NA, Ayed A. Retrocaval Ureter With Ureteric Stones: A Case Report. Cureus 2024; 16:e58826. [PMID: 38784323 PMCID: PMC11114088 DOI: 10.7759/cureus.58826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
The retrocaval ureter is an uncommon anomaly where the ureter passes behind the inferior vena cava. Open surgery had been the gold standard for treatment. We are presenting a case of the retrocaval ureter with ureteral calculi, which was effectively managed by open surgery. A 27-year-old male presented with a nine-month history of flank pain. He had no history of chronic illnesses. Physical examinations and laboratory findings were within normal. A computed tomography (CT) scan was done to confirm the diagnosis of retrocaval ureter with ureteral stones. The subcostal incision was made. Then, the proximal and lower ureter was transected at the point where it went retrocaval. The stones were extracted; then, watertight anastomosis was done. Ultrasound used for the follow-up of the patient for six months showed no hydronephrosis. Retrocaval ureteral may have no symptoms or be linked to nonspecific symptoms. The diagnosis of the retrocaval ureter is frequently delayed. Surgical management is utilized in the majority of cases.
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Affiliation(s)
- Raed Alwadai
- Department of Urology, King Abdullah Hospital, Ministry of Health, Bisha, SAU
| | - Naif A Alqarni
- Department of Medicine, College of Medicine, University of Bisha, Bisha, SAU
| | - Abdullah Ayed
- Department of Surgery, College of Medicine, University of Bisha, Bisha, SAU
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Yağız B, Yağmur İ, Hancıoğlu S, Demirel BD, Karagözlü Akgül A, Kaynak Şahap S. I Thought I Saw a Retrocaval Ureter; Don't Bite the Fish-Hook Sign So Easily. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37976210 DOI: 10.1089/lap.2023.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: During the management of patients with hydronephrosis, a possibility of retrocaval ureter (RCU) may emerge indicated by a fish-hook sign or its mimickers. Owing to infrequent incidence, the proper way to diagnose or exclude an RCU is challenging and has not been discussed previously. Methods: The aim of this study was to retrospectively evaluate the children who were suspected to have an RCU during management for urinary tract dilation. An RCU may be missed or misdiagnosed owing to rare incidence. Results: The children with urinary tract dilation in whom RCU was considered are enrolled in the study (n = 13). The demographics of the patients, findings suggesting RCU, evaluation process, management, and final diagnosis are retrospectively evaluated. The final diagnosis of the patients was RCU (n = 4), ureteropelvic junction obstruction (UPJO) (n = 7), and duplicated collecting system (n = 2). An RCU was confirmed or excluded by ultrasonography (US) while there was a stent in the ureter in 6 patients and by laparoscopic exploration in the other 7 patients. Four underwent correction for RCU, 7 for UPJO, 1 for reflux, and 1 ureterocele puncture. Conclusion: The fish-hook sign is a rare conflicting radiological finding that can be encountered in imaging studies. This uncommon finding needs confirmation or exclusion of a possible RCU as missed cases manifested after failed pyeloplasty or ureteroneocystostomy were reported. Radiological evaluation (by US or cross-sectional studies) while there is a stent in the ureter is the most satisfactory radiological technique to confirm or exclude an RCU. Alternatively, being aware of a possible RCU and performing a more extensive dissection may be necessary during surgery to confirm or exclude it. If available, laparoscopy may provide this goal in a minimally invasive manner with superior visualization.
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Affiliation(s)
- Beytullah Yağız
- Division of Pediatric Urology, Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - İsmail Yağmur
- Division of Pediatric Urology, Department of Urology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Sertaç Hancıoğlu
- Division of Pediatric Urology, Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Berat Dilek Demirel
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ahsen Karagözlü Akgül
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University Faculty of Medicine, Pendik, İstanbul, Turkey
| | - Seda Kaynak Şahap
- Divison of Pediatric Radiology, Department of Radiology, Cebeci Kampüsü Çankaya, Faculty of Medicine, Ankara University, Ankara, Turkey
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4
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Gupta R, Kesar A, Mahajan A, Mehta A, Masood S. Transperitoneal laparoscopic ureteropyeloplasty of retrocaval ureter: Single surgeon experience and review of literature. Asian J Endosc Surg 2022; 15:90-96. [PMID: 34320694 DOI: 10.1111/ases.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Retrocaval ureter (RCU) is a rare congenital abnormality, secondary to anomalous development of inferior vena cava (IVC) presenting as ipsilateral obstruction needing surgical intervention. The aim of this article is to present surgical techniques and outcome of transperitoneal laparoscopic ureteropyeloplasty in patients with RCU treated by a single surgeon at a tertiary care center and with review of literature. MATERIAL AND METHODS We conducted a retrospective, institutional review board approved chart review of patients who underwent transperitoneal laparoscopic ureteropyeloplasty for RCU at our unit between January 2010 and December 2020. A total of 10 patients were identified. Preoperative evaluation involved a computed tomography-intravenous urography in addition to the conventional evaluation. All the patients underwent dismembered transperitoneal laparoscopic ureteropyeloplasty over a Double J stent. Data analyzed included the demographic profile, operative time difficulty if any, postoperative, intraoperative complications and functional outcome. RESULTS All cases were completed laparoscopically and no open conversion was required. Average operating time was 96.6 minutes ± 8.16. Average blood loss was 71 ± 14.49 mL with an analgesia requirement of 115 ± 33.74 mg. One patient developed postoperative urinary leak and responded to percutaneous nephrostomy drainage. Patients were followed up for 3 to 12 months with a serial ultrasound and a follow-up diethylene-triamine-penta-acetic acid renal scan at 3 months to rule out any anastomotic site obstruction. CONCLUSION Transperitoneal laparoscopic ureteropyeloplasty for RCU was associated with minimal morbidity and good outcomes.
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Affiliation(s)
- Rahul Gupta
- Department of Urology, GMC Jammu, Jammu, India
| | | | - Arti Mahajan
- Department of Anesthesia, GMC Jammu, Jammu, India
| | - Anjali Mehta
- Department of Anesthesia, GMC Jammu, Jammu, India
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Inoue Y, Naitoh Y, Ajiki J, Fukui A, Yamada T, Fujihara A, Yamada K, Hongo F, Ukimura O. Robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction due to aberrant blood vessel with ipsilateral retrocaval ureter. IJU Case Rep 2021; 4:273-276. [PMID: 34497981 PMCID: PMC8413217 DOI: 10.1002/iju5.12304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Ureteropelvic junction obstruction is a common congenital anomaly that causes hydronephrosis but rarely accompanies ipsilateral retrocaval ureter. CASE PRESENTATION A 39-year-old woman, who visited to our hospital complaining of worsened right low back pain and fever, was diagnosed with right hydronephrosis due to ureteropelvic junction obstruction by contrast-enhanced computed tomography. Intraoperatively before the planned robot-assisted laparoscopic pyeloplasty, retrograde pyelography was performed to reveal concomitant ipsilateral retrocaval ureter. Laparoscopically, ureteropelvic junction obstruction due to aberrant blood vessel and coexisting retrocaval ureter was confirmed. Transposition of the ureter from posterior to anterior of the inferior vena cava and following dismembered pyeloplasty was performed. Two years after surgery, her right hydronephrosis improved and she had no complain of any symptom. CONCLUSION Retrocaval ureter is a rare abnormality; however, combination of preoperative retrograde pyelography and laparoscopic evaluation was important for management of this concomitant abnormality.
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Affiliation(s)
- Yuta Inoue
- Department of UrologyKyoto Prefectural University of MedicineKyotoJapan
| | - Yasuyuki Naitoh
- Department of UrologyKyoto Prefectural University of MedicineKyotoJapan
| | - Jun Ajiki
- Department of UrologyKyoto Prefectural University of MedicineKyotoJapan
| | - Ayako Fukui
- Department of UrologyKyoto Prefectural University of MedicineKyotoJapan
| | - Takeshi Yamada
- Department of UrologyKyoto Prefectural University of MedicineKyotoJapan
| | - Atsuko Fujihara
- Department of UrologyKyoto Prefectural University of MedicineKyotoJapan
| | - Kaori Yamada
- Department of Diagnostic RadiologyKyoto First Red Cross HospitalKyotoJapan
| | - Fumiya Hongo
- Department of UrologyKyoto Prefectural University of MedicineKyotoJapan
| | - Osamu Ukimura
- Department of UrologyKyoto Prefectural University of MedicineKyotoJapan
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6
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Noda Y, Naiki T, Naiki‐Ito A, Kato H, Etani T, Shimizu N, Nagai T, Iwatsuki S, Hamamoto S, Yasui T. Rare case of carcinoma in situ originated in right retrocaval ureter successfully managed with laparoscopic procedure. IJU Case Rep 2020; 3:128-131. [PMID: 33392470 PMCID: PMC7770590 DOI: 10.1002/iju5.12163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/11/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A retrocaval ureter is a rare congenital abnormality characterized by the persistence of the posterior subcardinal vein on the right, which causes the proximal ureter to deviate medially behind the inferior vena cava. The presence of retrocaval ureter is usually found because of the development of progressive hydronephrosis, but many cases are clinically silent. In addition, an urothelial malignancy associated with retrocaval ureter is very rare. CASE PRESENTATION Herein we report a very rare case of a 57-year-old male with retrocaval ureter and carcinoma in situ diagnosed by ureteroscopy. In spite of strong adhesion in the area of the ureter behind the inferior vena cava, dissection was successfully managed by a laparoscopic procedure after cutting the ureter and separating it into two segments. CONCLUSION Early histopathological diagnosis and radical laparoscopic surgery based on the results of ureteroscopy may lead to a good outcome, even in retrocaval ureter cases with a carcinoma in situ.
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Affiliation(s)
- Yusuke Noda
- Department ofNephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Taku Naiki
- Department ofNephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Aya Naiki‐Ito
- Department ofExperimental Pathology and Tumor BiologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Hiroyuki Kato
- Department ofExperimental Pathology and Tumor BiologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Toshiki Etani
- Department ofNephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Nobuhiko Shimizu
- Department ofNephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Takashi Nagai
- Department ofNephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Shoichiro Iwatsuki
- Department ofNephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Shuzo Hamamoto
- Department ofNephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Takahiro Yasui
- Department ofNephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
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Cavaleri Y, Farullo G, Nappo SG, Caione P. Laparoscopic Dismembered Repair in Two Patients with Retrocaval Ureter. European J Pediatr Surg Rep 2020; 8:e32-e34. [PMID: 32550123 PMCID: PMC7180074 DOI: 10.1055/s-0040-1705156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 01/10/2020] [Indexed: 11/01/2022] Open
Abstract
Retrocaval ureter (RCU) or circumcaval ureter is a rare cause of congenital hydronephrosis. The surgical correction of RCU should be performed in all patients with obstruction and hydronephrosis symptoms, lumbar pain, urinary tract infections, hematuria, or urolithiasis. Traditionally, an open surgical approach was used for the treatment of RCU. Nowadays, surgical correction of these anomalies is performed using minimally invasive techniques. We report on two cases treated with our standardized laparoscopic technique using only three 5-mm trocars. The proposed approach could be considered as the first-line treatment for RCU.
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Affiliation(s)
- Yuri Cavaleri
- Department of Surgery, Urology UOSD, University of Rome Tor Vergata, Roma, Lazio, Italy
| | - Giuseppe Farullo
- Department of Surgery, Urology UOSD, University of Rome Tor Vergata, Roma, Lazio, Italy
| | - Simona Gerocarni Nappo
- Department of Nephrology and Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Caione
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Peycelon M, Rembeyo G, Tanase A, Muller CO, Blanc T, Alhazmi H, Paye-Jaouen A, El Ghoneimi A. Laparoscopic retroperitoneal approach for retrocaval ureter in children. World J Urol 2019; 38:2055-2062. [PMID: 31187204 DOI: 10.1007/s00345-019-02849-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/08/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Retrocaval ureter (RCU) is a rare congenital anomaly and published data on pediatric laparoscopic management are poor. The aim of this study was to report our experience of retroperitoneal laparoscopic approach for management of RCU in children. METHODS A retrospective review of data from patients treated for RCU between 2002 and 2018 in our institution was performed. All patients were positioned in a flank position and underwent a three-port (5-mm optical trocar and two 3-mm trocars) laparoscopic retroperitoneal ureteroureterostomy. Anastomosis was made by 6/0 absorbable sutures. A JJ stent was always inserted. RESULTS Five patients with a median age of 94 months (5-152) were operated on and followed up for a median time of 103 months (46-201). Median operating time was 200 min (160-270). No conversion and no transfusion occurred. Median hospital stay was 2 days (1-4). Ureteral stent was removed after 52 days (47-82). Complications included pyelonephretis (N = 1). In all cases, hydronephrosis decreased postoperatively. CONCLUSIONS Retroperitoneal laparoscopic approach for RCU is safe and effective in children. Our video demonstrates different patients with specific surgical details to show how to manage these children. The global vision of the upper tract by laparoscopy leads to optimal management of these children even if the anomaly was not detected preoperatively.
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Affiliation(s)
- Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Robert-Debré University Children's Hospital, Assistance-Publique Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75935, Paris, France. .,Reference Center for Rare Diseases (CRMR) Malformations Rares des Voies Urinaires (MARVU), Paris, France.
| | - Grégory Rembeyo
- Department of Pediatric Surgery and Urology, Robert-Debré University Children's Hospital, Assistance-Publique Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75935, Paris, France
| | - Anca Tanase
- Department of Radiology, Robert-Debré University Children's Hospital, Assistance-Publique Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Cécile Olivia Muller
- Department of Pediatric Surgery and Urology, Robert-Debré University Children's Hospital, Assistance-Publique Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75935, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Robert-Debré University Children's Hospital, Assistance-Publique Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75935, Paris, France
| | - Hamdan Alhazmi
- Department of Pediatric Surgery and Urology, Robert-Debré University Children's Hospital, Assistance-Publique Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75935, Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert-Debré University Children's Hospital, Assistance-Publique Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75935, Paris, France.,Reference Center for Rare Diseases (CRMR) Malformations Rares des Voies Urinaires (MARVU), Paris, France
| | - Alaa El Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré University Children's Hospital, Assistance-Publique Hôpitaux de Paris, University Paris Diderot, Sorbonne Paris Cité, 48, Boulevard Sérurier, 75935, Paris, France.,Reference Center for Rare Diseases (CRMR) Malformations Rares des Voies Urinaires (MARVU), Paris, France
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9
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Abdessater M, El Khoury R, Elias S, Bart S, Coloby P, Sleiman W. Diagnosis and laparoscopic management of retrocaval ureter: A review of the literature and our case series. Int J Surg Case Rep 2019; 59:165-175. [PMID: 31170558 PMCID: PMC6551479 DOI: 10.1016/j.ijscr.2019.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 11/05/2022] Open
Abstract
The main advantage of minimally invasive techniques for the treatment of retrocaval ureter is less blood loss during surgery. Other advantages are shorter hospital stay, less postoperative pain and superior esthetic results. Pure laparoscopic treatment (as in our two cases) seems feasible and technically reliable with excellent functional outcome. Intracorporeal anastomosis of the ureter remains the main limiting factor.
Objectives To expose the diagnosis and the different laparoscopic approaches for the surgical management of patients with retrocaval ureter (RCU) and to share our experience on two cases. Methods Updated literature review on Pubmed and debating personal experiences including ours (double j stent insertion before the surgery, use of 4 trocards, transperitoneal approach, pyelopyelostomy for the anastomosis…), concerning the laparoscopic treatment of the RCU. Results Laparoscopic treatment of RCU is a recommended management for many reasons: less blood loss during the surgery, a shorter hospital stay, less postoperative pain and superior esthetic results with excellent functional results. All of these findings were also a part of our experience on the two reported cases: operative time was 210 and 180 min with no significant bleeding, hospital stay was 48 h post operatively for both patients that were symptom free with no renal dilation after 2 years of close follow up. The main cause of the increased operating time is the intracorporeal anastomosis of the ureter which remains the main limiting factor of the laparoscopic surgery. Conclusions The literature review has clearly shown the advantages of minimally invasive techniques for the treatment of retrocaval ureter. Pure laparoscopic treatment (as in our two cases), seems feasible and technically reliable, and should be the standard surgical option for the treatment of RCU.
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Affiliation(s)
- Maher Abdessater
- Centre hospitalier régional René DUBOS, Pontoise, France; Centre hospitalier universitaire Notre Dame des Secours, Byblos, Lebanon.
| | - Raghid El Khoury
- Centre hospitalier universitaire Notre Dame des Secours, Byblos, Lebanon
| | - Sandra Elias
- Centre hospitalier universitaire Notre Dame des Secours, Byblos, Lebanon
| | - Stephane Bart
- Centre hospitalier régional René DUBOS, Pontoise, France
| | - Patrick Coloby
- Centre hospitalier régional René DUBOS, Pontoise, France
| | - Walid Sleiman
- Centre hospitalier régional René DUBOS, Pontoise, France
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Temiz MZ, Nayak B, Aykan S, Singh P, Colakerol A, Semercioz A, Muslumanoglu AY. Laparoscopic and robotic transperitoneal repair of retrocaval ureter: A comparison of the surgical outcomes from two centres with a comprehensive literature review. J Minim Access Surg 2019; 16:115-120. [PMID: 30777994 PMCID: PMC7176004 DOI: 10.4103/jmas.jmas_293_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Mustafa Zafer Temiz
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
- Address for correspondence: Dr. Mustafa Zafer Temiz, Department of Urology, Bagcilar Training and Research Hospital, Merkez Mahallesi, Dr. Sadik Ahmet Cad, 34200, Istanbul, Turkey. E-mail:
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Serdar Aykan
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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11
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Seo IY, Oh TH, Jeon SH. Transperitoneal laparoscopic ureteroureterostomy with excision of the compressed ureter for retrocaval ureter and review of literature. Investig Clin Urol 2019; 60:108-113. [PMID: 30838343 PMCID: PMC6397927 DOI: 10.4111/icu.2019.60.2.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose We present surgical techniques and operative results of laparoscopic reconstruction for patients with retrocaval ureter (RCU) and review similar papers. Materials and Methods Ten patients with RCU were enrolled in this study from April 2005 to January 2017. The mean age of 7 males and 3 females was 40.5 years old. The chief complaint was flank pain in 6 patients; the remaining patients were detected incidentally. All patients showed hydronephrosis and typical S-shaped deformity of the ureter on imaging studies. Five patients showed obstructed patterns on the renal scans. Two surgeons performed laparoscopic ureteroureterostomies with transperitoneal approaches including excision of the compressed ureter. Double-J ureteral stents were inserted intraoperatively. The operative and follow-up results were checked and compared with published papers. Results All laparoscopic reconstructions were successfully completed without conversion to open surgery. The mean operative time was 199.6 minutes. The estimated blood loss was 154.4 mL. No operative complications were encountered. There were no obstruction and symptom after the mean follow-up of 40.7 months. We found 7 papers from PubMed, which had more than five cases of laparoscopic reconstruction of RCU. We reviewed and summarized the clinical and operative parameters. Conclusions Our results show that transperitoneal laparoscopic ureteroureterostomy with excision of the compressed ureter is a safe and effective treatment for RCU. Data from published papers and ours summarize clinical parameters of RCU, and suggest that the laparoscopic reconstruction can be considered as the standard treatment for it.
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Affiliation(s)
- Ill Young Seo
- Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine and Hospital, Iksan, Korea
| | - Tae Hoon Oh
- Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine and Hospital, Iksan, Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University Hospital, Seoul, Korea
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Guttilla A, Fiorello M, Fulcoli V, Andrisano A, Massari D, Costa G. A Case of Retrograde Treatment of a Ureteral Stone in a Retrocaval Ureter. J Endourol Case Rep 2018; 4:198-200. [PMID: 30671541 PMCID: PMC6340374 DOI: 10.1089/cren.2018.0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Retrocaval ureter is a rare entity with a reported incidence of ∼1 in 1100 and a 2.8-fold male predominance. The course of the ureter could be classified, using an intravenous urography, as type 1 having S-shaped, fish-hook, or J-shaped retrocaval course or type 2 having sickle-shaped course. No case report describing retrograde endoscopic management of ureteral calculi in the presence of retrocaval ureter could be found in existing literature. We are presenting a case of type I retrocaval ureter with ureteral calculi and nonobstructive drainage, which was effectively managed by flexible ureteroscopy. Case Presentation: A 62-year-old Caucasian man presented with complaints of a renal colic. The patient was positive for a history of noninsulin-dependent diabetes and hypertension. A direct abdomen CT scan showed an 8 mm ureteral stone with suspected retrocaval course of right proximal ureter with no hydronephrosis. After informed consent, ureteroscopy was performed on the patient's right proximal ureter. No complications occurred intraoperatively and postoperatively. On follow-up of up to 3 months, patient was asymptomatic and direct abdomen CT scan showed normal kidney without hydronephrosis. Conclusion: In the presence of retrocaval ureter and associated ureteral calculi with a condition of nonobstructive drainage, retrograde ureteroscopy is a safe and optimal procedure.
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Affiliation(s)
- Andrea Guttilla
- Urology Department, Camposampiero Hospital, ULSS 6 "Euganea," Camposampiero, Italy
| | - Mario Fiorello
- Urology Department, Camposampiero Hospital, ULSS 6 "Euganea," Camposampiero, Italy
| | - Vittorio Fulcoli
- Urology Department, Camposampiero Hospital, ULSS 6 "Euganea," Camposampiero, Italy
| | - Alessandro Andrisano
- Urology Department, Camposampiero Hospital, ULSS 6 "Euganea," Camposampiero, Italy
| | - Domenico Massari
- Urology Department, Camposampiero Hospital, ULSS 6 "Euganea," Camposampiero, Italy
| | - Giuseppe Costa
- Urology Department, Camposampiero Hospital, ULSS 6 "Euganea," Camposampiero, Italy
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Mejdoub I, Bouassida M, Mseddi MA, Fourati M, Hadjslimen M, Rebai N. Laparoscopic approach for retrocaval ureter: How to decrease surgical time? Urol Case Rep 2018; 20:106-107. [PMID: 30116716 PMCID: PMC6083818 DOI: 10.1016/j.eucr.2018.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/25/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ibrahim Mejdoub
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Mehdi Bouassida
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Mohamed Amine Mseddi
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Mohamed Fourati
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Mourad Hadjslimen
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Nouri Rebai
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
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Tamhankar AS, Savalia AJ, Sawant AS, Pawar PW, Kasat GV, Patil SR. Transperitoneal laparoscopic repair of retrocaval ureter: Our experience and review of literature. Urol Ann 2017; 9:324-329. [PMID: 29118532 PMCID: PMC5656955 DOI: 10.4103/ua.ua_52_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Ashwin S Tamhankar
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Abhishek J Savalia
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Ajit S Sawant
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Prakash W Pawar
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Gaurav V Kasat
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Sunil R Patil
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Transperitoneal Laparoscopic Pyelopyelostomy for Retrocaval Ureter without Excision of the Retrocaval Segment: Experience on Three Cases. Adv Urol 2016; 2016:5709134. [PMID: 27403160 PMCID: PMC4923527 DOI: 10.1155/2016/5709134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/23/2016] [Accepted: 05/31/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction. Retrocaval ureter is a rare congenital anomaly. Open surgery was the classic treatment for this condition. Laparoscopy is currently an admitted procedure to treat many urological diseases. The objective of our study is to present our experience and discuss the safety and the feasibility of transperitoneal laparoscopic pyelopyelostomy for treatment of retrocaval ureter (RCU). Materials and Methods. Three symptomatic patients underwent laparoscopic repair for RCU in our department. The diagnosis was suspected on the computed tomography scan (CT) and confirmed on ascending pyelography. After placement of a JJ stent, and, using the transperitoneal approach, the retro peritoneum was exposed; the ureter was identified in both sides of the vena cava. The retrocaval segment was entirely mobilized and pulled from behind of the vena cava after section of renal pelvis. A pyelopyelostomy was done in a normal anatomic position. Results. All operations were achieved laparoscopically without conversion to open surgery. The mean operative time was 140 minutes (110–190). No intraoperative complication occurred. Blood loss was less than 50 mL in all patients. The mean hospital stay was 5 days (4–6 days). All patients were symptom-free after surgery and had reduction of hydronephrosis in control imagery. Conclusion. Laparoscopy seems safe, feasible, and reproducible in managing retrocaval ureter.
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Liu E, Sun X, Guo H, Li F, Liu S, Wang K, Hou Y. Retroperitoneoscopic ureteroplasty for retrocaval ureter: report of nine cases and literature review. Scand J Urol 2016; 50:319-22. [PMID: 27151645 DOI: 10.1080/21681805.2016.1177589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to report the experience of retroperitoneal laparoscopic ureteroplasty for nine cases of retrocaval ureter. MATERIAL AND METHODS Six males and three females were referred with a diagnosis of retrocaval ureter. A retroperitoneal laparoscopic approach was taken in all patients, who were diagnosed by intravenous pyelography (IVP), computed tomography urography and retrograde pyelography. After the dilated proximal ureter was mobilized, the ureter was transected just above the retrocaval segment, which was repositioned to the anterior of the vena cava. The retrocaval segment was observed and evaluated to enable a decision as to whether or not to reserve. Then, tension-free, water-tight anastomosis was performed with absorbable sutures using intracorporeal suturing techniques over a double-J stent, which was laparoscopically inserted in an antegrade manner. The stent was removed 4-6 weeks postoperatively. RESULTS The ureteroplasty was accomplished in all cases. The retrocaval segment of the ureter was reserved with a grossly normal appearance in six cases; the abnormal retrocaval segment was excised in the three other cases. The mean operative duration was 103 min (range 89-110 min) and the mean hospital stay was 7 days (range 6-9 days). No serious complications occurred. Follow-up by ultrasonography and IVP, lasting 6 months to 4 years, revealed considerable improvement in hydronephrosis and upper ureteral dilatation. No ureteral stenosis was found at the anastomotic site. CONCLUSION Retroperitoneoscopic ureteroplasty should be recommended as the first line treatment for retrocaval ureter because of its advantages of minimal invasion and shorter hospital stay than open surgery. Skilled laparoscopic anastomosis with a retroperitoneal approach can shorten the operative duration.
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Affiliation(s)
- Erpeng Liu
- a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China
| | - Xiao Sun
- a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China
| | - Hui Guo
- a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China
| | - Faping Li
- a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China
| | - Shukun Liu
- a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China
| | - Kaixuan Wang
- a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China
| | - Yuchuan Hou
- a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China
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Steinhaus J, Berent A, Weisse C, Eatroff A, Donovan T, Haddad J, Bagley D. Clinical presentation and outcome of cats with circumcaval ureters associated with a ureteral obstruction. J Vet Intern Med 2015; 29:63-70. [PMID: 25270055 PMCID: PMC4858092 DOI: 10.1111/jvim.12465] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/24/2014] [Accepted: 08/25/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Circumcaval ureters (CU) are a rare embryological malformation resulting in ventral displacement of the caudal vena cava, which crosses the ureter, potentially causing a ureteral stricture. OBJECTIVES To evaluate cats with obstructed CU(s) and report the presenting signs, diagnostics, treatment(s), and outcomes. Cats with obstructed CU(s) were compared to ureterally obstructed cats without CU(s). ANIMALS 193 cats; 22 circumcaval obstructed (Group 1); 106 non-circumcaval obstructed (Group 2); 65 non-obstructed necropsy cases (Group 3). METHODS Retrospective study, review of medical records for cats treated for benign ureteral obstructions from AMC and University of Pennsylvania between 2009 and 2013. INCLUSION CRITERIA surgical treatment of benign ureteral obstruction, complete medical record including radiographic, ultrasonographic, biochemistry, and surgical findings. RESULTS Seventeen percent (22/128) of obstructed cats had a CU (80% right-sided) compared to 14% (9/65) non-obstructed necropsy cats (89% right-sided). Clinical presentation, radiographic findings, and creatinine were not statistically different between Groups 1 and 2. Strictures were a statistically more common (40%) cause of ureteral obstruction in Group 1 compared to Group 2 (17%) (P = .01). The MST for Groups 1 and 2 after ureteral decompression was 923 and 762 days, respectively (P = .62), with the MST for death secondary to kidney disease in both groups being >1,442 days. Re-obstruction was the most common complication in Group 1 (24%) occurring more commonly in ureters of cats treated with a ureteral stent(s) (44%) compared to the subcutaneous ureteral bypass (SUB) device (8%) (P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE Ureteral obstructions in cats with a CU(s) have a similar outcome to those cats with a ureteral obstruction and normal ureteral anatomy. Long-term prognosis is good for benign ureteral obstructions treated with a double pigtail stent or a SUB device. The SUB device re-obstructed less commonly than the ureteral stent, especially when a ureteral stricture was present.
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Affiliation(s)
- J. Steinhaus
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - A.C. Berent
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - C. Weisse
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - A. Eatroff
- Department of Internal MedicineBluePearl Veterinary PartnersNew YorkNY
| | - T. Donovan
- Department of Anatomic PathologyThe AMCNew YorkNY
| | - J. Haddad
- Department of Anatomic and Clinical PathologyIdexx LaboratoriesNew YorkNY
| | - D. Bagley
- Thomas Jefferson UniversityPhiladelphiaPA
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18
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Berent AC, Weisse CW, Todd K, Bagley DH. Technical and clinical outcomes of ureteral stenting in cats with benign ureteral obstruction: 69 cases (2006–2010). J Am Vet Med Assoc 2014; 244:559-76. [DOI: 10.2460/javma.244.5.559] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Qin C, Wang S, Li P, Cao Q, Shao P, Li P, Han Z, Tao J, Meng X, Ju X, Song R, Li J, Zhang W, Lu Q, Yin C. Retroperitoneal laparoscopic technique in treatment of complex renal stones: 75 cases. BMC Urol 2014; 14:16. [PMID: 24491207 PMCID: PMC3918106 DOI: 10.1186/1471-2490-14-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/31/2014] [Indexed: 11/13/2022] Open
Abstract
Background In most hospitals, several options for the management of renal stones are available: shockwave lithotripsy, endourologic treatment, or surgery. Choice of treatment is based on the anatomic characteristics of the patient, and the location and size of the stones. In this study we assessed a retroperitoneal laparoscopic technique for treatment of complex renal stones. Methods Seventy-five patients, including 53 men and 22 women with a mean age of 47.8 years (range 18–74 y), underwent retroperitoneal laparoscopy for the treatment of complex renal stones between July 2006 and November 2012 in our hospital. Results The retroperitoneal laparoscopic procedures for treatment of complex renal stones were completely successful in 73 cases, while 2 cases converted to open surgery. The operative time was 85–190 min with a mean of 96 min. The estimated blood lost was 20–400 mL with a mean of 80 mL. After the operation 7 patients experienced urinary leakage. Ultrasonography, x-ray of the kidney, ureter and bladder, and intravenous urography were reviewed at post-procedural follow-up at 6–82 months. No hydronephrosis aggravation was found, and there was no calculus recurrence. Conclusion The merits of retroperitoneal laparoscopy for the treatment of complex renal stones include sparing the nephron, less bleeding, short hospitalization, quick postoperative recovery, and controllable procedure after training Success depends on the experience of surgeons and judicious selection of cases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Qiang Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China.
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Prakash J, Raj A, Sankhwar S, Singh V. Renal calculi with retrocaval ureter: is percutaneous nephrolithotomy sufficient? BMJ Case Rep 2013; 2013:bcr-2013-008889. [PMID: 23536623 DOI: 10.1136/bcr-2013-008889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old woman presented with complaints of intermittent right flank pain which had begun one year ago. Ultrasonography and intravenous urogram showed right pelvic (15 mm) and inferior calyceal (6 mm) calculi along with suspected retrocaval course of right ureter, which was confirmed by contrast CT scan. Tc-99m diethylene-triamine-penta-acetic acid (DTPA) scan showed normal function and normal drainage of right kidney. Percutaneous nephrolithotomy (PCNL) was performed for right renal calculi. Because of curved ureteric course, negotiation of ureteric catheter in pelvis was anticipated to be troublesome, so intraoperative retrograde pyelogram (RGP) was performed to delineate the anatomy. Puncture was performed safely after air contrast pyelography. No complications occurred intraoperatively and postoperatively. On follow-up of up to 1 year patient was asymptomatic and renal scan showed normal function and drainage. So in the presence of retrocaval ureter and associated renal calculi, PCNL is a safe and optimal procedure and in condition of non-obstructive drainage, management of calculi only is adequate.
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Affiliation(s)
- Jai Prakash
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
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21
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Chen Z, Chen X, Luo YC, He Y, Li NN, Xie CQ, Lai C, Fang XL. Retroperitoneal laparoendoscopic single-site ureterolithotomy and ureteroureterostomy for retrocaval ureter with ureteral calculus: first case report. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2012; 46:437-40. [PMID: 22624948 DOI: 10.3109/00365599.2012.691112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 53-year-old man presented with a 6-month history of intermittent right flank pain. Radiological imaging confirmed the diagnosis of retrocaval ureter (RCU) and ureteral calculus. Retroperitoneal laparoendoscopic single-site surgery (LESS) ureterolithotomy and ureteroureterostomy was successfully performed. The operative time was 185 min and the blood loss was approximately 20 ml. The patient's postoperative course was uneventful. Postoperative analgesia was not needed. The patient was discharged on the third postoperative day. The drain and double-J stent were respectively removed at 1 and 8 weeks postoperatively. At the 3-month follow-up, nuclear scan showed no evidence of obstruction of the right kidney and the patient also remained symptom free. It may be concluded that retroperitoneal LESS repair for RCU is a feasible and safe procedure, which can be considered as a option for the management of RCU even if it is complicated by the presence of a ureteral calculus.
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Affiliation(s)
- Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Abraham GP, Das K, Ramaswami K, Siddaiah AT, George DP, Abraham JJ, Thampan OS, Pratap T, Jacob SM. Upper Ureteric Obstruction Secondary to Entrapment Between Twin Segments of Inferior Vena Cava—An Unusual Occurrence. Urology 2012; 79:e65-6. [DOI: 10.1016/j.urology.2012.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/02/2012] [Accepted: 02/07/2012] [Indexed: 11/28/2022]
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Alkhudair WK, Seyam R, Al Zahrani HM, Al Otaibi MF, Al Taweel W. Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment. Can Urol Assoc J 2012; 6:E38-41. [PMID: 22511429 DOI: 10.5489/cuaj.10121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Maintaining the retrocaval ureteric segment further facilitates the procedure. We report a case of a 23-year-old man who underwent intraperitoneal robotic resection anastomosis and repositioning of the retrocaval ureter. We also discuss the advantages of this technique.
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Affiliation(s)
- Waleed K Alkhudair
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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24
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Chen S, Xu B, Liu J, Ren Q, Hu X, Yang Y, Zhang X, Chen M. Retroperitoneal laparoscopic reconstruction for retrocaval ureter: experience and literature review. J Endourol 2012; 26:1147-52. [PMID: 22471654 DOI: 10.1089/end.2012.0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We describe surgical techniques and experience with retroperitoneal laparoscopic pyeloureterostomy in five cases of retrocaval ureter (RU). We also report the laparoscopic approach reconstruction for RU from peer-reviewed publications. PATIENTS AND METHODS Five patients with RU underwent retroperitoneal laparoscopic pyeloureterostomy. Nuclear renography, intravenous urography (IVU), and ultrasonography follow-up was performed postoperatively. Science Citation Index searches were conducted to identify laparoscopic reconstruction for RU outcomes. Studies published after 1994 were included in the analysis. RESULTS Operations were completed successfully and without complications in five patients. The mean operative time was 90.2 ± 34.4 minutes. The mean time needed to insert the Double-J stent and reanastomosis was 51.2 ± 11.4 minutes. Blood loss was minimal. Over a follow-up of 12 to 37 months, hydronephrosis was found to decrease substantially. There were 24 peer-reviewed studies covering a total of 62 patients suitable for inclusion in our final analysis. The most common method for reconstruction of the ureter was ureteroureterostomy, followed by pyeloureterostomy and pyelopyelotomy. CONCLUSION Retroperitoneal laparoscopy for RU is a safe and effective procedure that should be considered as a first-line treatment for patients with this anatomic anomaly.
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Affiliation(s)
- Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Medical School of Southeast University, Nan Jing, China
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Chen Z, Chen X, Wu ZH, Luo YC, Li NN. Treatment of Retrocaval Ureter by Retroperitoneal Laparoscopic Ureteroureterostomy: Experience on 12 Patients. J Laparoendosc Adv Surg Tech A 2011; 21:803-7. [PMID: 21854202 DOI: 10.1089/lap.2011.0211] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhong-Hua Wu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Cheng Luo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Nan-Nan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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LeRoy TJ, Thiel DD, Igel TC. Robot-assisted laparoscopic reconstruction of retrocaval ureter: description and video of technique. J Laparoendosc Adv Surg Tech A 2011; 21:349-51. [PMID: 21486152 DOI: 10.1089/lap.2010.0287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ureteral obstruction secondary to retrocaval ureter is rarely reported in the urologic literature. Symptomatic retrocaval ureters usually present in the 3rd and 4th decade of life. Standard treatment involves ureteroureterostomy approximating the ureter anterior to the vena cava. We describe the initial presentation, imaging, port placement, and operative technique including video presentation of a robot-assisted laparoscopic repair of a retrocaval ureter.
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Affiliation(s)
- Timothy J LeRoy
- Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 32224, USA
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Retroperitoneal Laparoscopic Ureteroureterostomy for Retrocaval Ureter: Report of 10 Cases and Literature Review. Urology 2010; 76:873-6. [DOI: 10.1016/j.urology.2009.12.056] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 11/11/2009] [Accepted: 12/22/2009] [Indexed: 11/18/2022]
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Singh O, Gupta SS, Hastir A, Arvind NK. Laparoscopic transperitoneal pyelopyelostomy and ureteroureterostomy of retrocaval ureter: Report of two cases and review of the literature. J Minim Access Surg 2010; 6:53-5. [PMID: 20814513 PMCID: PMC2924550 DOI: 10.4103/0972-9941.65166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 02/09/2010] [Indexed: 11/08/2022] Open
Abstract
We report two cases of retrocaval ureter that were successfully treated by a laparoscopic transperitoneal approach. Presentation of both these cases was with flank pain. Ureteroureterostomy using an intracorporeal suture technique was performed for one, and pyelopyelostomy for the other case. Operative time was 120 min and 110 min, respectively. Pyelopyelostomy was technically easier to perform than ureteroureterostomy that required an extra fourth port insertion to facilitate dissection. With increasing experience with the intracorporeal suturing laparoscopic technique of either pyelopyelostomy or ureteroureterostomy should be the first choice for retrocaval ureter.
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Affiliation(s)
- Onkar Singh
- Department of Urology, Bhopal Memorial Hospital & Research Centre, Bhopal - 462 038, India
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Abstract
Retrocaval ureter is abnormal looping of the proximal ureter behind the inferior vena cava. The aberrant anatomy results in the compression of the ureter causing hydronephrosis. This is a very infrequent cause of hydronephrosis in children. Association of retrocaval ureter with a stone in the looping segment of the ureter is extremely rare. We report one such pediatric case which was diagnosed preoperatively with a review of pediatric-only cases reported in last 5 years.
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Dogan HS, Oktay B, Vuruskan H, Yavascaoglu I. Treatment of Retrocaval Ureter by Pure Laparoscopic Pyelopyelostomy: Experience on 4 Patients. Urology 2010; 75:1343-7. [DOI: 10.1016/j.urology.2009.09.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 08/09/2009] [Accepted: 09/16/2009] [Indexed: 11/26/2022]
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Autorino R, Khanna R, White MA, Haber GP, Shah G, Kaouk JH, Stein RJ. Laparoendoscopic single-site repair of retrocaval ureter: first case report. Urology 2010; 76:1501-5. [PMID: 20381132 DOI: 10.1016/j.urology.2010.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 01/13/2010] [Accepted: 01/18/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We describe a case of retrocaval ureter treated with laparoendoscopic single-site surgery (LESS). METHODS A 26-year-old female was referred to our institution with a history of intermittent right-sided flank pain. Radiological imaging demonstrated hydronephrosis, suggesting the presence of a retrocaval ureter. A LESS repair was planned. RESULTS Retrograde pyelogram confirmed a classic appearance for retrocaval ureter. A ureteral stent was positioned. The patient was placed in modified flank position. A 2-cm, completely concealed umbilical access was created, through which a single port access platform was positioned. An in-line endoscope was used for visualization. Articulating instruments were used during initial dissection. The entire ureter was mobilized posterior to the vena cava and transected at the caudal-most point where the dilated portion of the proximal ureter ended. The distal ureter was repositioned lateral to the inferior vena cava and spatulated laterally. The proximal ureter was spatulated medially. Two 4-0 Vicryl sutures were used for the ureteroureteral anastomosis. A separate 2-mm grasper placed in the right lower quadrant was used to assist with suture reconstruction. A drain was left through the umbilicus. Blood loss was minimal. Total operative time was 3 hours. The patient was discharged on postoperative day 2. At the 3-month follow-up, diuretic radionuclide scan revealed no evidence of obstruction of the right kidney and the patient was symptom-free. CONCLUSIONS Albeit challenging, LESS repair for retrocaval ureter is a feasible procedure that can be considered as a treatment option for this rare anatomic anomaly.
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Affiliation(s)
- Riccardo Autorino
- Center for Laparoscopy and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Answer to radiological quiz. Med J Armed Forces India 2010. [DOI: 10.1016/s0377-1237(10)80144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Laparoscopic Repair of Circumcaval Ureter: One-year Follow-up of Three Patients and Literature Review. Urology 2009; 74:148-53. [DOI: 10.1016/j.urology.2009.02.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 01/07/2009] [Accepted: 02/09/2009] [Indexed: 11/17/2022]
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Hemal AK, Rao R, Sharma S, Clement RGE. Pure robotic retrocaval ureter repair. Int Braz J Urol 2008; 34:734-8. [PMID: 19111078 DOI: 10.1590/s1677-55382008000600008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2008] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Ranjit Rao
- Wake Forest University Health Sciences, USA; All India Institute of Medical Sciences, India
| | - Sachit Sharma
- Wake Forest University Health Sciences, USA; All India Institute of Medical Sciences, India
| | - Rhys G. E. Clement
- Wake Forest University Health Sciences, USA; All India Institute of Medical Sciences, India
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Chung BI, Gill IS. Laparoscopic dismembered pyeloplasty of a retrocaval ureter: case report and review of the literature. Eur Urol 2008; 54:1433-6. [PMID: 18805629 DOI: 10.1016/j.eururo.2008.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
Abstract
A retrocaval ureter is a rare entity that has traditionally been treated with open pyeloplasty techniques. In this paper, we describe the successful performance of a laparoscopic dismembered pyeloplasty for a retrocaval ureter and present important technical points. In reviewing the available literature about this technique, the laparoscopic approach should be considered to be first-line treatment for this anatomic anomaly due to the good track record, quick convalescence, and relative technical ease.
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Affiliation(s)
- Benjamin I Chung
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Abstract
Retrocaval ureter has been traditionally corrected surgically through an open retroperitoneal procedure; however, in recent years, the correction has been accomplished using laparoscopy. The great advantages of this procedure remain limited because of the prolonged time it takes to complete the intracorporeal suture of the ureter, besides the need for a highly experienced surgeon. We present a case in which the ureter was freed using laparoscopy, and the ureteral anastomosis was carried out extracorporeally, which notably diminished the duration of the surgery. This technique would have limited use in obese patients, patients with ureters of limited length, patients with very proximal obstructions of the ureter, and patients with risk of devascularization of both ureteral segments. However, the technique does appear effective and reproducible in adequately selected patients.
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Affiliation(s)
- Jesús Angel Fernández-Fernández
- Department of Pediatric Urology, Hospital of Pediatric Specialties of Maracaibo, University of Zulia, 4006 Maracaibo, Venezuela.
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Ballesteros Sampol J. [Retrocaval ureter]. Actas Urol Esp 2008; 32:368. [PMID: 18512400 DOI: 10.1016/s0210-4806(08)73848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Duchene DA, Thiel DD, Winfield HN. Robotic-Assisted Laparoscopic Ureteropyelostomy for Treatment of Prostatitis Secondary to Ectopic Ureteral Insertion of a Completely Duplicated Collecting System. J Endourol 2007; 21:455-7. [PMID: 17523894 DOI: 10.1089/end.2006.0431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Symptomatic presentation of a completely duplicated collecting system with upper-pole ectopic ureteral insertion is rare in the adult. We present a case of a 52-year-old man with recurrent prostatitis and hematuria secondary to an ectopic ureteral insertion from a left upper-pole moiety in a completely duplicated collecting system. He underwent a robot-assisted laparoscopic ureteropyelostomy with good results. We describe our technique in this unusual case.
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Affiliation(s)
- David A Duchene
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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