Retroperitoneal Laparoscopic Approach for Retrocaval Ureter : Our Experience on 27 Cases

Introduction: Aim of this study was to describe the retroperitoneoscopic ureterouretostomy technique for retrocaval ureter. Materials and Methods: Retrospective single centre study of 27 patients who underwent retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter. Treatment success was defined as the absence of stenosis, reduction of hydronephrosis and complete resolution of symptoms. Intra and post-operative complications and short-term follow-up were assessed. A descriptive statistical analysis was performed. Wilcoxon signed rank test was used to compare hydronephrosis grade and symptoms resolution after 3, 6 and 12 months. Results: Median operative time was 131 min (IQR: 90-160) and median estimated blood loss was 28,5 ml (10-30); median hospital stay was 3,8 days (IQR: 3-4). No intra-operative complications or conversion to open surgery were observed. After surgery 15% (4 of 27) had a grade 1 of Clavien-Dindo complications. The double-J ureteral stent was removed 4-6 weeks postoperatively. The Contrast-enhanced CT scan performed at 3, 6 and 12 months after surgery, showed no ureteral stricture along the anastomotic tract, perfect ureteric anastomosis and a decrease of hydronephrosis, confirmed at ultrasonography. Conclusion: Retroperitoneal laparoscopic approach allows to identifying inferior vena cava and ureter faster, with less influence of abdominal organs. Our study showed a feasible and safe surgical approach in a large case series.