PMC6551479_01
Renal ultrasound of patient 1 showing severe right-sided hydronephrosis.
gr1.jpg
PMC6551479_01_gr1.jpg
fig0005
Renal ultrasound showed severe right-sided hydronephrosis (Fig. 1) and computed tomography scan suggested the presence of a RCU (Fig. 2).
KUB of patient 1 showing the double J stent that takes the S shape of the ureter.
gr3.jpg
PMC6551479_01_gr3.jpg
fig0015
The patient was treated with intravenous antibiotics and drainage of the right kidney by a double J stent (Fig. 3) with retrograde ureteropyelography that confirmed the diagnosis of retrocaval ureter (Fig. 4), antibiotic treatment continued for 2 weeks orally, and laparoscopic repair of retrocaval ureter was planned after sterilization of the urine.
PMC6551479_02
Renal ultrasound of patient 2 showing severe right-sided hydronephrosis.
gr5.jpg
PMC6551479_02_gr5.jpg
fig0025
Renal ultrasound demonstrated sever right-sided hydronephrosis (Fig. 5) and computed tomography scan suggested the presence of a retrocaval ureter (Fig. 6), Serum testing demonstrated preserved renal function, and a laparoscopic repair of retrocaval ureter was planned, with a right retrograde ureteropyelography (Fig. 7), done just before the surgery for a retrograde double J stent placement (Fig. 8), and confirmed the diagnosis of retrocaval ureter.
Right retrograde ureteropyelography of patient 2 showing the S shape of the ureter.
gr7.jpg
PMC6551479_02_gr7.jpg
fig0035
Renal ultrasound demonstrated sever right-sided hydronephrosis (Fig. 5) and computed tomography scan suggested the presence of a retrocaval ureter (Fig. 6), Serum testing demonstrated preserved renal function, and a laparoscopic repair of retrocaval ureter was planned, with a right retrograde ureteropyelography (Fig. 7), done just before the surgery for a retrograde double J stent placement (Fig. 8), and confirmed the diagnosis of retrocaval ureter.
Trocars' positions (same laparoscopic technique for the two patients).
gr9.jpg
PMC6551479_02_gr9.jpg
fig0045
The 5-mm fourth trocar was placed for traction on midaxillary line at the level of the umbilicus (Fig. 9).
Dilated proximal renal pelvis and ureter were found and separated from the adjacent tissue by a blunt and sharp dissection.
gr10.jpg
PMC6551479_02_gr10.jpg
fig0050
Toldt line, the dilated proximal renal pelvis and ureter were found and separated from the adjacent tissue by a blunt and sharp dissection (Fig. 10). Traction of the proximal ureter by a stich of the renal pelvis through the abdominal wall, helped to identify the distal ureteral segment which was released without damaging the periureteral soft tissue.
Transection at the ureteropelvic junction.
gr11.jpg
PMC6551479_02_gr11.jpg
fig0055
After the complete release of the ureteral segment beneath the inferior vena cava, the dilated renal pelvis was transected at the ureteropelvic junction (Fig. 11).
Persistence of the posterior cardinal vein ventral to the ureter entrapping it.
gr12.jpg
PMC6551479_02_gr12.jpg
fig0060
Because of the persistence of the posterior cardinal vein that is located ventral to the ureter, the ureter will become entrapped behind the vein (Fig. 12).
RCU Type I (low loop) with the dilated proximal ureter assuming the shape of a reverse "J".
gr13.jpg
PMC6551479_02_gr13.jpg
fig0065
Type I (low loop) (Fig. 13) is the most common, with the dilated proximal ureter assuming the shape of a reverse "J".