With most published data based on case reports and small case series, utilization of laparoscopy for noncalculous ureteral surgery remains in its infancy. However, as the urologic community's experience with laparoscopy grows, a dramatic increase in laparoscopic applications to the ureter is likely to be seen in the next decade. The principles of surgical approaches to the retrocaval ureter, idiopathic retroperitoneal fibrosis, transureteroureterostomy, cutaneous ureterostomy, and ureteroneocystostomy in adults are discussed in this chapter.

Persistence of the lumbar segment of the subcardinal vein beyond early development results in the formation of the retrocaval ureter (also known as the circumcaval ureter or preureteral vena cava).

The principles of repair with the laparoscopic approach are similar to those of open surgery. The retrocaval ureteral segment has to be mobilized to a location anterior and lateral to the cava. When the ureter encircles the cava, dismemberment with reanastomosis is needed. When the ureter does not encircle the cava, a simple ureterolysis may be sufficient.

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