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11–14 APRIL, 2018, HELSINKI, FINLAND
10:03–10:08
S6-7 (VP)
RETROCAVAL URETER: AN UNEXPECTED
INTRAOPERATIVE FINDING DURING ROBOTIC REDO
PYELOPLASTY
Hamdan ALHAZMI
1
, Santiago VALLASCIANI
2
, Abdulazeem ABASHER
2
,
Saeed ALSHAHRANI
2
, Hossam ALJALLAD
2
, Ahmed ALMATHAMI
2
, Fadi AZAR
3
,
Ahmad ALSHAMMARI
4
and Craig PETERS
5
1) King Saud University, King Saud University Medical City, Pediatric Urology Division, Department of Surgery, Riyadh,
SAUDI ARABIA - 2) King Faisal Specialist Hospital and Research Center, Pediatric Urology Division, Urology Dept,
Riyadh, SAUDI ARABIA - 3) King Faisal Specialist Hospital and Research Center, Nursing Department, Riyadh,
SAUDI ARABIA - 4) National Guard Hospital, Pediatric Urology Division, Surgery Dept, Riyadh, SAUDI ARABIA -
5) Children's Medical Center, University of Texas Southwestern, Pediatric Urology Division, Surgery Dept, Dallas, USA
PURPOSE
Reoperative Pelvi Ureteric Junction obstruction (PUJO) cases are challenging due to the presence
of scarring and anatomic distortion. In this video the unexpected intraoperative discovery of a high
retrocaval ureter and its management are illustrated.
MATERIAL AND METHODS
a 3-year old male underwent open right Anderson-Hynes dismembered pyeloplasty through
a flank incision at age 12 months. In 24 months of follow-up ultrasound and MAG3 scans revealed
persistent severe hydronephrosis with an initially delayed washout pattern that bacame frankly ob-
structed. Robotic redo pyeloplasty was recommended. Retrograde pyelogram revealed a S-shape
proximal ureter with a short narrow segment. Using a 3-trocar robotic approach the proximal ureter
was found to be surrounded by scar tissue and with an abnormal retrocaval course. The ureter
and lower pelvis were mobilized carefully from behind the cava. The prior anatomosis was visibly
patent. A dismembered pyeloplasty was done with anterior transposition and partial excision of the
retrocaval ureter.
DISCUSSION
Reoperative pyeloplasty requires careful exposure of the proximal ureter and ureteropelvic junction
to define the anatomy and determine the cause of the failure of the first procedure. The laparoscopic
approach provides excellent vision and exposure of all the structures potentially involved in the
recurrence. This case demonstrates the possibility of an unrecognized retrocaval ureter as a cause
for pyeloplasty failure.
CONCLUSION
In the case presented, even if unexpected, the retrocaval course of the ureter was able to be man-
aged with this approach.
10:08–10:20
Discussion