Retrocaval ureter is a relatively rare anomaly that usually manifests in the third or fourth decades. Due to the persistence of the right subcardinal vein in the lumbar area, the vena cava develops ventral of the right ureter zhang et al, 1990. Full blood count, urinalysis and blood urea and creatinine were normal. Circumcaval ureter, also known as retrocaval ureter, is a term used to describe an abnormal course of a ureter that encircles the inferior vena cava. The images showed that the upper part of the right ureter was dilated and the portion.
Type ii is less common and the retrocaval segment of the ureter crosses higher at the level of the renal pelvis. The major radiographic features are the marked medial deviation of the ureter. Surgery is needed for symptomatic cases and involves transection and relocation of the ureter anterior to the ivc. Retrocaval ureter is a rare congenital anomaly, with the ureter passing posterior to the inferior vena cava. Retrocaval ureter and contra lateral renal agenesis a. Persistence of both ventral and dorsal limbs will result in the ureter passing between the cavae. Duplication of ivc is another rare congenital anomaly in the development of ivc. Read retrocaval ureter and associated abnormalities, international urology and nephrology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life from a resulting hydronephrosis.
Gladstones case, that of an acardiac monster, is the only example on record to date. Variations of the renal veins are well described in the literature, although variations concerning the ureter are considered a rare finding in cats. The axial ct below shows the inferior ureter white arrow coursing posterior to the inferior vena cava red arrow. A pelvipelvic anastomosis was fashioned with eight interrupted 40. Three asymptomatic patients were diagnosed by routine physical examination.
Right circumcaval ureter and double right renal vein in. In 1893, hochstetter first described retrocaval ureter. Incidental finding of retrocaval ureter in a patient without hydronephrosis. Pdf laparoscopic ureterolysis and reconstruction of a. A case of retrocaval ureter with recurrent pyelonephritis is presented with discussion of these clinical entities.
Retrocaval ureter with recurrent pyelonephritis waseda. Retrocaval ureter also referred to as circumcaval ureter or preureteral vena cava is a rare congenital anomaly with the ureters passing posterior to the inferior vena cava. Anomalous development of the vena cava preureteric vena cava allows the infrarenal vena cava to form anterior to the ureter usually the right. Links to pubmed are also available for selected references. Contrastenhanced ct and diuretic renography are the methods of choice to. Standard treatment involves ureteroureterostomy approximating the ureter anterior to the vena cava. Four types of retrocaval ureter have been observed in man. Retrocaval ureter is a rare anomaly due to an abnormal development. All of the patients had type 2 and rightsided retrocaval ureter. Urinalysis was negative for red blood cells, white blood cells, or protein. Retrocaval ureter is a rare condition that results from an anomaly in the development of the inferior vena cava. Retrocaval ureter medigoo health medical tests and.
This is the 2nd such case out of 110 cases reported in japan. Both of these terms are somewhat misleading, as this configuration is considered a developmental anomaly of the inferior vena cava ivc. The big black arrow shows the inferior vena cava, while the small black one indicates the. First described by hochstetter in 1893, retrocaval ureter also known as circumcaval ureter is a rare congenital anomaly and the incidence is greater in males than females with the ratio of 2. Contralateral perinephric urinoma complicated retrocaval. Retrocaval ureter is a rare anomaly due to an abnormal development of the inferior vena cava in.
A retrocaval ureter, which is also called circumcaval ureter, is an abnorm development of vena cava and ureter. A surgical trap of pyelic fusion anomaly rabea ahmed gadelkareem assiut urology and nephrology hospital, faculty of medicine, assiut university, assiut, egypt. Laparoendoscopic singlesite repair of retrocaval ureter. Its etiology is assumed to be abnormal embryologic development of the inferior vena cava as a result of atrophy failure of the right subcardinal vein in the lumbar portion. Symptoms are due to ureteric obstruction, either extrinsic by the abnormal inferior vena cava. Here, ureter passes between the inferior vena cava ivc and psoas muscle and gets compressed. Medial deviation of the ureter should lead to a suspicion of a retrocaval ureter. Pain on percussion of the right lumbar region was evident on physical examination.
Full text full text is available as a scanned copy of the original print version. Case 1 was a 20yearold woman who presented with symptoms of a right ureter stone. Abnormal course of the left ureter, dorsally to the left inferior vena cava. A case of retrocaval ureter associated with carcinoma of the renal pelvis has been presented. Rajeevan 1 1 department of urology, government medical college, calicut, kerala, india abstract article info. Ct scan below the level of the kidneys demonstrates a more medial retrocaval placement of the right ureter.
Diagnosis of retrocaval ureter should increase the awareness of the responsible physician on the possibility of concomitant malformations where treatment could prevent future symptoms. A rare case of right retrocaval ureter with duplication of. Contralateral perinephric urinoma complicated retrocaval ureter repair. Though congenital,it commonly manifests in the third to fourth decade of life. Robotassisted laparoscopic reconstruction of retrocaval. Pdf retrocaval ureter is a rare congenital anomaly in which the ureter passes behind, and is compressed by, the inferior vena cava. Laparoscopic ureteroureterostomy for retrocaval ureter. The ureter is slightly dilated proximal to this point and returns to a normal position distal to its retrocaval placement. It is suggested that long term stagnation of urine is the cause for such a high incidence of. Retrocaval ureter definition of retrocaval ureter by. Its rarity and nonspecific presentation pose a challenge to surgeons and radiologists in making the correct.
The ureter, instead of passing lateral to the vena cava, passes behind it, partially encircles it for a short distance, and then pursues its normal course ventral to the vena cava, downward into the bony pelvis and thence to the bladder. The circumcaval ureter is one of the rarest variations of the ureter and is characterised by a loop of the ureter posterior to the caudal vena cava. Diagnosis and treatment of the circumcaval ureter european. Associated anomalies were seen in none of the patients. To present a case of pyelic fusion anomaly with orthotopic kidneys which is extremely rare. Symptoms are due to ureteric obstruction, either extrinsic by the abnormal inferior vena cava ivc, or intrinsic ureteric hypoplasia. Although it is a congenital anomaly, the patient presents later in life, from a resulting hydronephrosis. The ureter has an arterial supply which varies along its course. Development of the inferior vena cava in the light of recent research, with special.
To download the pdf, click the download link below. Campbell 5 stated in his 1963 textbook that about 90 cases had been reported to date, and the diagnosis was made preoperatively in 28. Usually ureterogram in conjunction with venacavogram can establish diagnosis. Retrocaval ureter rcu is a rare congenital anomaly with the ureter looping around inferior vena cava ivc. This variant is also known as preureteral vena cava and retrocaval ureter. Retrocaval ureter is still a rare congenital anomaly. Retrocaval ureter is a rare congenital anomaly in which the ureter passes behind, and is compressed by, the inferior vena cava. The ureter is medial to the pedicle of the vertebral body blue arrow. Ureteral anomalies msd manual professional edition. Cilr 2016 miguel ramos laparoscopic retrocaval right ureter duration. The designation preureteric vena cava more accurately. We describe the initial presentation, imaging, port placement, and operative technique including video presentation of a robotassisted laparoscopic repair of a retrocaval ureter. The vascular anomaly which results in a venous trunk lying anterior to the ureter so that the latter structure must completely encircle it en route to the bladder has been variously described as a postcaval ureter, a precaval ureter and a circumcaval ureter. The upper part of the ureter closest to the kidney is supplied by the renal arteries.
Alternatively, you can also download the pdf file directly to your computer, from where it can be opened using a pdf reader. Left retrocaval ureter associated with urothelial malignancy. A 14 year old male presented with a three months history of right flank pain that was of sudden onset and initially colicky but had become constant. Mullen and engel state that 55 cases have been reported. Retrocaval ureter also referred to as preureteral vena cava is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava. Its symptom is nonspecific, and urography is the key.
Pdf the aim of this study was to report our 23year experience in the diagnosis and treatment of retrocaval ureter. Ivp and ct demonstrate partial obstruction of the right renal collecting system with a retrocaval ureter. Retrocaval circumcaval ureter associated with solitary. Retrocaval ureter a rare cause of hydronephrosis in children. The term retrocaval ureter is used interchangeably with circumcaval or postcaval ureter, which describes the anatomic relationship of the ureter to the embryologically abnormal inferior vena cava. Retrocaval ureter is a rare congenital abnormality resulting in the ureter passing dorsal to and being obstructed by the inferior vena cava.
Abstract two cases of retrocaval ureter are reported that were successfully treated by a laparoscopic approach. Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly which commonly presents with loin pain in middle age group. Incidental finding of retrocaval ureter in a patient. We present a case of a 49yearold male who presented with loin pain and upon. Coronal reformatted mips image from a ct urogram demonstrates medial displacement of the right ureter at the level of l3 white arrow. Learningradiology retrocaval ureter, circumcaval ureter. Unfortunately both term suggest that ureter is at fault whereas in reality it is the ivc. Retrocaval ureter is a congenital abnormality resulting from persistence of the subcardinal vein and gives rise to various degrees of obstructive uropathy. Murphy, md, javier casillas, md, and josluis becerra, md the computed tomography and sonography appearance of retrocaval ureter is correlated with findings on intravenous urography. An excretory urogram and retrograde ureterogram disclosed pronounced hydronephrosis as well as a dilated proximal part and reversed jshaped appearance of the right ureter.
Retrocaval ureter is a rare anomaly in the paediatric age group. By gentle traction on the lower ureter containing the dj stent, the retrocaval portion was freed up, pulled out of from around the ivc, and transposed laterally. Renal calculi are also present, presumably due to stasis. The prevalence of this condition is approximately 1 per 1,000 persons, with males 23 times more likely than females to develop the condition. Retrocaval ureter, circumcaval ureter, flank pain, hydronephrosis, ureteroureterostomy introduction retrocaval ureter also referred to as circumcaval ureter or preureteral vena cava is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava. Diagnosis and treatment of retrocaval ureter abstract european. A retrocaval ureter circumcaval ureter is a developmental anamoly of inferior vena cava ivc. The incidence was reported to be approximately 1 in people, with male predominance. A 60yearold man presented with a 30year history of back pain which had worsened over 3 days. Retrocaval ureter is a rare cause of hydronephrosis. The ureter classically course medially behind the inferior vena cava winding around it and then passes laterally in front of it to then course distally to the bladder. Get a printable copy pdf file of the complete article 2.
Case report minimally invasive approach of a retrocaval ureter. The hydronephrosis is due to kinking of the ureter. A retrocaval ureter is a rare anomaly in children and needs a high index of suspicion to be detected early in life. Division of the ureter, careful mobilization and disengagement from its retrocaval to an antecaval position, and anastomosis of the severed ends, with or without intubation, is the surgical technic employed to conserve renal function. A preureteric vena cava, also known as a retrocaval ureter, is a rare congenital malformation of the right human ureter, in which the ureter passes behind the inferior vena cava, causing compression possibly leading to hydronephrosis. The middle part of the ureter is supplied by the common iliac arteries, direct branches from the abdominal aorta, and gonadal arteries the testicular artery in men or ovarian artery in women. The embryologic pathology, diagnosis and treatment of the disorder are discussed.
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