Presented by: Sergey Sukhikh PhD
Moscow state university of medicine and dentistry named after A.I. Evdokimov

Introduction

Retrocaval ureter is a rare condition caused by an anomaly of the inferior vena cava (IVC). However, when symptoms appear, most often by the age of 30-40 years, this diagnosis remains little known to specialists. This paper presents a clinical case of a patient with retrocaval ureter and a surgical method of treatment for this disease.

Materials

A 30-year-old woman complains of right lumbar pain radiating to the right side of the abdomen. The pain was intense and recurrent for 2 years (3-4 times a month), more often at night, relieved after urination. The patient was observed by a gynecologist, surgeon, neurologist. Retrocaval ureter (type II - the intersection with the IVC is at the level of the renal pelvis) was diagnosed on a CT scan with contrast. The ultrasound examination with intravenous furosemide 20 mg revealed ureteropyelocalicoectasia on the right side at 5 and 15 min of the examination. The patient underwent robot-assisted reconstruction of a retrocaval ureter (antecaval ureteroureterostomy).   

Results

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The da Vinci Xi robotic system was used, 3 robotic ports, 2 assistant ports and an optical port were set. The operation time was 60 min. Blood loss was 30 ml. There were no perioperative complications. The ureteric stent was removed 1 month after the operation. The regression of pain syndrome was noted. After 3, 6 months there were performed renal ultrasound tests, CT with contrast, which excluded dilation of the right renal pelvis and calyxes and confirmed the positive results of surgical treatment. 

Conclusion

Robot-assisted ureteroureterostomy is a safe and effective procedure and an excellent minimally invasive treatment for retrocaval ureter. Given the positive short-term result (9 months of follow-up), we plan to continue dynamic follow-up of this patient.

Funding

No

Co-Authors

Vigen Malkhasyan, MD
Moscow state university of medicine and dentistry named after A.I. Evdokimov

Konstantin Kolontarev, MD
Moscow state university of medicine and dentistry named after A.I. Evdokimov

Dmitry Pushkar, MD
Moscow state university of medicine and dentistry named after A.I. Evdokimov