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Laparoscopic Roux-en-Y stapled cystojejunostomy

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Laparoscopic Ureteroureterostomy: Right Retrocaval Ureter

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Sargent Eric,
University Of California, Irvine,
Orange


ABSTRACT:
Laparoscopic Ureteroureterostomy: Right Retrocaval Ureter

Eric R. Sargent, M.D., Hak J. Lee, M.D., and Elspeth M. McDougall, M.D.
Department of Urology, University of California, Irvine, USA

Introduction: Embryologically, retrocaval ureter is most accurately described as preureteral vena cava. This vascular anomaly arises from failure of the subcardinal veins to atrophy in their entirety during development. The lumbar component of the subcardinal vein persists as the infrarenal vena cava, crossing anterior to the middle segment of the ureter. Ureteral obstruction may result from the retrocaval location of the mid-ureter.

Methods: We present a case of right ureteral obstruction due to the retrocaval location of the mid-ureter in a 24 year-old female. The epidemiology and embryology of retrocaval ureter is discussed first, followed by a description of radiographs utilized in the diagnostic evaluation of this condition before and after surgical therapy. Treatment to resolve the right ureteral obstruction by laparoscopic excision of the stenotic retrocaval segment and ureteroureterostomy is shown.

Results: The preoperative radiographic evaluation of retrocaval ureter includes CT scanning, retrograde pyelography, and diuretic renography. Laparoscopic ureteroureterostomy entails mobilization of the obstructed collecting system, and proximal and mid-ureter, followed by ureteral transaction proximal to the level of obstruction. The retrocaval segment is brought anterior and lateral to the inferior vena cava, and the ureteral stenosis is excised. Continuity of the ureter is re-established by ureteroureterostomy. The patient’s postoperative course is discussed with emphasis on the use of postoperative diuretic renography to document the absence of right ureteral obstruction following laparoscopic surgical therapy.

Conclusions: Retrocaval ureter is a vascular anomaly which may result in ureteral obstruction. Laparoscopic excision of the retrocaval segment and ureteroureterostomy is an effective treatment for this condition.
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