Laparoscopic Trans-Peritoneal Uretero-Ureterostomy for Retro-Caval Ureter: A Single-Center Experience

Abstract Introduction: Retrocaval ureter (RCU) is a rare congenital anomaly in which the ureter passes posterior to the inferior vena cava, leading to upper urinary tract stasis. This condition is often misdiagnosed and can result in significant complications due to obstructed urine flow. The feasibility of laparoscopic repair is reported in this study. Materials and Methods: We retrospectively analyzed 13 patients who underwent laparoscopic uretero-ureterostomy for RCU between 2020 and 2024. All patients underwent pre-operative evaluation using computed tomography (CT) urogram or magnetic resonance (MR) urogram and nuclear functional imaging. Intraoperatively, a retrograde pyelogram (RGP) was performed to confirm the diagnosis. Laparoscopic uretero-ureterostomy was performed under general anesthesia in all cases. Pre-operative, demographic, and intraoperative data were recorded. Follow-up assessments were conducted to monitor for urinary symptoms and other post-operative complications. Results: All 13 surgeries were completed laparoscopically, with no conversions to open surgery. The average operative time was 118.37 min. Two patients developed Clavien–Dindo Grade 1 complications postoperatively. Five patients experienced stent-related symptoms during their first follow-up, which resolved with symptomatic treatment. At 3 months post-operatively, 69.2% of patients showed asymptomatic static hydronephrosis on serial ultrasound, while 30.8% exhibited resolution of hydronephrosis. A follow-up diethylenetriamine pentaacetate (DTPA) renal scan at 6 months confirmed that there was no obstruction at the anastomotic site in any of the operated patients. Conclusion: Laparoscopic repair of RCU is an effective surgical approach and is increasingly being adopted as part of the urological treatment arsenal.