Laparoscopic Treatment Of Retrocaval Ureter

BackgroundRetrocaval(circumcaval) ureter is an uncommon congenital anomaly in which the right ureter courses posterior to the inferior vena cava because of abnormal development of vena cava in embryonal phase, it causes right hydronephrosis and upper ureteral dilation for obstruction of ureter. It was first described by Hochstetter in 1893. Male is more than female (about 3-4 to 1) in morbidity of the disease. The main symptoms of this disease are right flank pain, hematuria or irritation of urinary system commonly in age 30-40. Usually, this disease was found in operation or autopsy other than pre-operation in the past. For the past few years the diagnosis of disease was elevated pre-operation because of the development of imaging technique and paying attention of doctor. Normally the treatment of the disease is open resetting and rectification of ureter.Since doctor Mouret in France completed laparoscopic cholecystectomy in human first time in 1987, the application oflaparoscopic operation was more and more in medical domain because of the advantage of minimal invasive n less injury > short convalescence and precise manipulation. In 1994, doctor Baba reported one case of retrocaval ureter which was treated by laparoscopic operation. Since that several case report could be seen in abroad journal, but case report was rare in china.The page report 5 cases of retrocaval ureter treated by laparoscopic operation associate with operation tiir^ blood loss^ convalescence post-operation and hydronephrosis amendment. To discuss the feasibility of laparoscopic treatment of retrocaval ureter currently.Methods1. Clinic materialBetween April 2002 and March 2006 five patients were included in this study. Four patients were male and one female. The age was 19~47, mean 33.8 years old. The course of disease was half of month to ten years. One case was found by B-ultrasound, other had right flank pain. All patients accepted IVU> RGP or CTU before operation.2. OperationAll patients accepted laparoscopic operation under general anesthesia., 3 cases pyelouretero-anastomosis, 2 cases ureterouretero-anastomosis.ResultsMean operative time was 3.1 hours (l~7hour);mean estimated blood loss was 82ml (30~150ml);mean time of drainage tube was 5.6 days;mean time of Foley catheter was 7.2 days;mean discharge time was 8.2 days. Symptom disappeared in all patients one month after operation. Hydronephrosis disappeared in two cases and decreased in two case, one case in fallow up.ConclusionsAs to surgeon with rich experiences of laparoscopy, especially laparoscopic suture, laparoscopic surgery of retrocaval ureter is the first choice other than traditional open operation for the advantage of minimal invasiveness ^ cosmetic cut and short convalescence.