Laparoscopic retroperitoneal approach for retrocaval ureter in children

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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Abbreviations

ANT:

Antenatal diagnosis

CT:

Computerized tomography

Diag:

Diagnosis

DRF:

Differential renal function

F:

Female

FU:

Follow-up

GV:

Gonadal vein

Hem.:

Hematuria

Int.:

Interrupted sutures

IVC:

Inferior vena cava

IVP:

Intravenous pyelography

kg:

Kilogram

LOS:

Length of stay

Lith:

Lithiasis

M:

Male

MAG3:

Mercaptoacetyltriglycine

Mg dL−1 :

Milligram per deciliter

mm:

Millimeter

MRI:

Magnetic resonance imaging

N:

Number

ND:

Not described

OT:

Operative time

Postop:

Postoperative

PP:

Pyelopyelostomy

Preop:

Preoperative

PU:

Pyeloureterostomy

PUJ(O):

Pelvi-ureteric junction (obstruction)

RCU:

Retrocaval ureter

RGP:

Retrograde pyelography

RP:

Retroperitoneal laparoscopic

Run:

Running suture

RUS:

Renal ultrasonography

Sympt:

Symptoms

TP:

Transperitoneal laparoscopic

UTI:

Urinary tract infection

UU:

Ureteroureterostomy

References

  1. 1.

    Pienkny AJ, Herts B, Streem SB (1999) Contemporary diagnosis of retrocaval ureter. J Endourol 13:721–722

    CAS  Article  Google Scholar 

  2. 2.

    Goodwin WE, Burke DE, Muller WH (1957) Retrocaval ureter. Surg Gynecol Obstet 104:337–345

    CAS  PubMed  Google Scholar 

  3. 3.

    Soundappan SVS, Barker AP (2004) Retrocaval ureter in children: a report of two cases. Pediatr Surg Int 20:158–160. https://doi.org/10.1007/s00383-003-1038-x

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    El-Ghoneimi A, Valla JS, Steyaert H, Aigrain Y (1998) Laparoscopic renal surgery via a retroperitoneal approach in children. J Urol 160:1138–1141

    CAS  Article  Google Scholar 

  5. 5.

    El-Ghoneimi A, Farhat W, Bolduc S, Bagli D, McLorie G, Aigrain Y et al (2003) Laparoscopic dismembered pyeloplasty by a retroperitoneal approach in children. BJU Int 92:104–108 (discussion 108)

    CAS  Article  Google Scholar 

  6. 6.

    Blanc T, Muller C, Abdoul H, Peev S, Paye-Jaouen A, Peycelon M et al (2013) Retroperitoneal laparoscopic pyeloplasty in children: long-term outcome and critical analysis of 10-year experience in a teaching center. Eur Urol 63:565–572. https://doi.org/10.1016/j.eururo.2012.07.051

    Article  PubMed  Google Scholar 

  7. 7.

    Baba S, Oya M, Miyahara M, Deguchi N, Tazaki H (1994) Laparoscopic surgical correction of circumcaval ureter. Urology 44:122–126

    CAS  Article  Google Scholar 

  8. 8.

    Salomon L, Hoznek A, Balian C, Gasman D, Chopin DK, Abbou CC (1999) Retroperitoneal laparoscopy of a retrocaval ureter. BJU Int 84:181–182

    CAS  Article  Google Scholar 

  9. 9.

    Ramalingam M, Selvarajan K (2003) Laparoscopic transperitoneal repair of retrocaval ureter: report of two cases. J Endourol 17:85–87. https://doi.org/10.1089/08927790360587397

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Simforoosh N, Nouri-Mahdavi K, Tabibi A (2006) Laparoscopic pyelopyelostomy for retrocaval ureter without excision of the retrocaval segment: first report of 6 cases. J Urol 175:2166–2169. https://doi.org/10.1016/s0022-5347(06)00269-2(discussion 2169)

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Chung BI, Gill IS (2008) Laparoscopic dismembered pyeloplasty of a retrocaval ureter: case report and review of the literature. Eur Urol 54:1433–1436. https://doi.org/10.1016/j.eururo.2008.09.010

    Article  PubMed  Google Scholar 

  12. 12.

    Baldwin DD, Dunbar JA, Wells N, McDougall EM (2003) Single-center comparison of laparoscopic pyeloplasty, acucise endopyelotomy, and open pyeloplasty. J Endourol 17:155–160. https://doi.org/10.1089/089277903321618716

    Article  PubMed  Google Scholar 

  13. 13.

    Uthappa MC, Anthony D, Allen C (2002) Case report: retrocaval ureter: MR appearances. Br J Radiol 75:177–179. https://doi.org/10.1259/bjr.75.890.750177

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Salonia A, Maccagnano C, Lesma A, Naspro R, Suardi N, Guazzoni G et al (2006) Diagnosis and treatment of the circumcaval ureter. Eur Urol Suppl 5:449–462. https://doi.org/10.1016/j.eursup.2006.02.009

    Article  Google Scholar 

  15. 15.

    Muthusami P, Ramesh A (2013) Appearances of the circumcaval ureter on excretory urography and MR urography: a single-center case series. Indian J Radiol Imaging 23:81–85. https://doi.org/10.4103/0971-3026.113621

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Claudon M, Durand E, Grenier N, Prigent A, Balvay D, Chaumet-Riffaud P et al (2014) Chronic urinary obstruction: evaluation of dynamic contrast-enhanced MR urography for measurement of split renal function. Radiology 273:801–812. https://doi.org/10.1148/radiol.14131819

    Article  PubMed  Google Scholar 

  17. 17.

    Ratkal JM, Jadhav R, Naique Dessai RR (2016) Circumcaval ureter—the paradigm shift in diagnosis and management. Indian J Surg 78:37–40. https://doi.org/10.1007/s12262-015-1352-2

    Article  PubMed  Google Scholar 

  18. 18.

    Bateson EM, Atkinson D (1969) Circumcaval ureter: a new classification. Clin Radiol 20:173–177

    CAS  Article  Google Scholar 

  19. 19.

    Dogan HS, Oktay B, Vuruskan H, Yavascaoglu I (2010) Treatment of retrocaval ureter by pure laparoscopic pyelopyelostomy: experience on 4 patients. Urology 75:1343–1347. https://doi.org/10.1016/j.urology.2009.09.040

    Article  PubMed  Google Scholar 

  20. 20.

    Gundeti MS, Duffy PG, Mushtaq I (2006) Robotic-assisted laparoscopic correction of pediatric retrocaval ureter. J Laparoendosc Adv Surg Tech A 16:422–424. https://doi.org/10.1089/lap.2006.16.422

    Article  PubMed  Google Scholar 

  21. 21.

    Miyazato M, Kimura T, Ohyama C, Hatano T, Miyazato T, Ogawa Y (2002) Retroperitoneoscopic ureteroureterostomy for retrocaval ureter. Hinyokika Kiyo 48:25–28

    PubMed  Google Scholar 

  22. 22.

    Lu L, Bi Y, Wang X, Ruan S (2017) Laparoscopic resection and end-to-end ureteroureterostomy for midureteral obstruction in children. J Laparoendosc Adv Surg Tech A 27:197–202. https://doi.org/10.1089/lap.2016.0222

    Article  PubMed  Google Scholar 

  23. 23.

    Tamhankar AS, Savalia AJ, Sawant AS, Pawar PW, Kasat GV, Patil SR (2017) Transperitoneal laparoscopic repair of retrocaval ureter: our experience and review of literature. Urol Ann 9:324–329. https://doi.org/10.4103/UA.UA_52_17

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Fernández-Fernández JA, Pachano-Arenas FE (2008) Laparoscopic-assisted correction of a retrocaval ureter. J Pediatr Surg 43:1560–1562. https://doi.org/10.1016/j.jpedsurg.2008.05.002

    Article  PubMed  Google Scholar 

  25. 25.

    Li H-Z, Ma X, Qi L, Shi T-P, Wang B-J, Zhang X (2010) Retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter: report of 10 cases and literature review. Urology 76:873–876. https://doi.org/10.1016/j.urology.2009.12.056

    Article  PubMed  Google Scholar 

  26. 26.

    Chen S, Xu B, Liu J, Ren Q, Hu X, Yang Y et al (2012) Retroperitoneal laparoscopic reconstruction for retrocaval ureter: experience and literature review. J Endourol 26:1147–1152. https://doi.org/10.1089/end.2012.0076

    Article  PubMed  Google Scholar 

  27. 27.

    Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH (2000) Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics 20:639–652. https://doi.org/10.1148/radiographics.20.3.g00ma09639

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Kokubo T, Okada Y, Yashiro N, Itai Y, Iio M (1990) CT diagnosis of retrocaval ureter associated with double inferior vena cava: report of a case. Radiat Med 8:96–98

    CAS  PubMed  Google Scholar 

  29. 29.

    El-Ghoneimi A, Abou-Hashim H, Bonnard A, Verkauskas G, Macher M-A, Huot O et al (2006) Retroperitoneal laparoscopic nephrectomy in children: at last the gold standard? J Pediatr Urol 2:357–363. https://doi.org/10.1016/j.jpurol.2006.04.005

    Article  PubMed  Google Scholar 

  30. 30.

    El-Ghoneimi A (2004) Laparoscopic management of hydronephrosis in children. World J Urol 22:415–417. https://doi.org/10.1007/s00345-004-0458-0

    Article  PubMed  Google Scholar 

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Author information

Affiliations

Authors

Contributions

MP: project development, data management, data analysis, manuscript writing. GR: project development, data collection. AT: data management, manuscript writing. COM: data collection, data analysis. TB: manuscript editing. HA: manuscript editing. AP-J: project development, data management, manuscript editing. AE-G: project development, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Matthieu Peycelon.

Ethics declarations

Ethical approval

This study had received Robert-Debré University Hospital review board approval. No help or financial support from any industrial firm has been declared. We have received a signed release form from the patient’s families authorizing this publication.

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All authors declare the following: Payment/services info: all authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous 3 years with any organizations that might have an interest in the submitted work. Other relationships: all authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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Peycelon, M., Rembeyo, G., Tanase, A. et al. Laparoscopic retroperitoneal approach for retrocaval ureter in children. World J Urol 38, 2055–2062 (2020). https://doi.org/10.1007/s00345-019-02849-w

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Keywords

  • Retrocaval ureter
  • Hydronephrosis
  • Multimodal imaging
  • Retroperitoneal space
  • Laparoscopy
  • Child