Open Surgical Repair of Retrocaval Ureter Without Excision of Retrocaval Segment: Results of 8 Cases in a Single-Center

INTRODUCTION: Retrocaval ureter (RU) is a rare congenital anomaly characterized by the passage of the ureter through the posterior of the vena cava. We aimed to present the data of 8 cases treated with open surgical repair without excision of the retrocaval segment.
METHODS: Eight patients who were operated with the diagnosis of RU in our clinic between 2005-2018 were included in the study. Demographic data, peri- and postoperative data of the patients were recorded and evaluated. In addition, imaging modalities were recorded. Pre- and postoperative values of T½ values in dynamic scintigraphy were compared. All patients underwent open ureterouretereral anostomosis without excision of the retrocaval segment. SPSS 22.0 was used for statistical analysis and p values less than 0.05 were considered statistically significant.
RESULTS: Five patients were male and 3 were female. The mean age was 36.2 years (25-48). The mean operation time was 64 minutes (58-92). Six patients (75%) presented with flank pain. The mean hospitalization duration was 2.32 days. In the postoperative period, all patients underwent computed tomography-urography and dynamic and static renal scintigraphy with nuclear medicine study. There was no statistically significant difference between preoperative and postoperative static scintigraphy values (p = 0.741), but dynamic renal scintigraphy difference was significant (T½ was 25.7 min. preoperatively and 14.4 min. postoperatively, p = 0.016).
DISCUSSION AND CONCLUSION: Re-anostomosis performed for the retrocaval ureter without any excision of the retrocaval segment yields successful results with minimal postoperative morbidity and short hospital stay.

Retrokaval Segmentin Eksizyonu Olmadan Retrokaval Üreterde Açýk Cerrahi Onarým: Tek-Merkezdeki 8 Olgunun Sonucu

GÝRÝÞ ve AMAÇ: Retrokaval üreter (RÜ), üreterin vena kavanýn posteriorundan geçmesiyle karakterize, oldukça nadir görülen bir konjenital anomalidir.Retrokaval segmentin eksizyonu olmadan açýk cerrahi onarým ile tedavi ettiðimiz 8 olgunun verilerini sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: 2005-2018 yýllarý arasýnda kliniðimizde RÜ tanýsý ile opere edilen 8 hasta çalýþmaya dahil edildi. Hastalarýn demografik verileri, peri- ve postoperatif verileri hasta dosyalarýndan kaydedildi ve deðerlendirildi. Ayrýca hastalara uygulanan görüntüleme yöntemleri kaydedildi. Dinamik sintigrafideki T½ deðerinin pre- ve postoperatif deðerleri karþýlaþtýrýldý. Tüm hastalara açýk yöntemle retrokaval segmentin eksizyonu olmadan üreteroüreteral anostomoz uygulandý. Ýstatistiksel analiz için SPSS 22.0 kullanýldý ve p deðerinin 0.05'den küçük deðerleri, istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Hastalarýn 5'i erkek, 3'ü kadýndý. Ortalama yaþ 36.2 yýldý (25-48). Ortalama operasyon süresi 64 dakikaydý (58-92). Altý hastada (%75) baþvuru yakýnmasý yan aðrýsýydý. Ortalama hastanede yatýþ süresi 2.32 gündü. Postoperatif dönemde tüm hastalara kontrol amacýyla bilgisayarlý tomografi-ürografi ve nükleer týp çalýþmasý ile dinamik ve statik renal sintigrafi uygulandý. Hastalarýn preoperatif ve postoperatif statik sintigrafileri arasýnda istatistiksel anlamlý bir iliþki yoktu (p=0.741) ancak, dinamik renal sintigrafi farklýlýðý anlamlýydý (preoperatif ortalama T½ deðeri 25.7 dk, postoperatif ortalama T½ deðeri ise 14.4 dk, p=0.016).
TARTIÞMA ve SONUÇ: Retrokaval segmentte eksizyon yapýlmaksýzýn retrokaval üretere uygulanan re-anostomoz, minimal postoperatif morbidite, kýsa hastanede kalýþ süresi ile baþarýlý sonuçlar saðlamaktadýr.