title: Retroperitoneoscopic ureteroplasty for retrocaval ureter: report of nine cases and literature review.
abstract: OBJECTIVE
  The aim of this study was to report the experience of retroperitoneal laparoscopic ureteroplasty for nine cases of retrocaval ureter.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China.
authors.forename: Erpeng
authors.initials: E
authors.lastname: Liu
authors.affiliation: a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Sun
authors.affiliation: a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China.
authors.forename: Hui
authors.initials: H
authors.lastname: Guo
authors.affiliation: a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China.
authors.forename: Faping
authors.initials: F
authors.lastname: Li
authors.affiliation: a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China.
authors.forename: Shukun
authors.initials: S
authors.lastname: Liu
authors.affiliation: a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China.
authors.forename: Kaixuan
authors.initials: K
authors.lastname: Wang
authors.affiliation: a Department of Urology , 1st Hospital of Jilin University , Changchun , PR China.
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Hou
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D064749:Retrocaval Ureter / Q000601:surgery*; D012187:Retroperitoneal Space; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: Retrocaval ureter; retroperitoneoscopy; ureteroplasty