Retrocaval ureter with carcinoma of the renal pelvis. Lap retrocaval ureter 12 30 min surgery video urology video. A retrocaval ureter courses toward the midline on the posterior aspect of the inferior vena cava before emerging medial and anterior to this structure and then descending into the pelvis. Retrocaval ureter should be included in the differential diagnosis for hydroureter in ferrets, especially if the ureter suffers medial displacement. The aim of this study is to report on our last nine years experience in the diagnosis and treatment of retrocaval ureter. Ct scan below the level of the kidneys demonstrates a more medial retrocaval placement of the right ureter. Left retrocaval ureter associated with inferior vena caval duplication. It is suggested that long term stagnation of urine is the cause for such a high incidence of. We present a case of a 49yearold male who presented with loin pain and upon. Intravenous urography and retrograde pyelography were used for confirming the diagnosis. Transposition and reanastomosis of the ureter is the treatment of choice in humans to relieve hydronephrosis salonia et al. Both of these terms are somewhat misleading, as this configuration is considered a developmental anomaly of the inferior vena cava ivc.
Retroperitoneoscopic ureteroplasty for retrocaval ureter. The proximal ureter deviates medially passing behind the ivc and winding around it before crossing anteriorly and laterally to resume its normal course distally. Pdf retrocaval ureter is a rare congenital anomaly in which the ureter passes behind, and is. Abstract two cases of retrocaval ureter are reported that were successfully treated by a laparoscopic approach. This anomaly occurs between the 4 th and 8 th weeks of intrauterine development and is due to abnormal formation of infrarenal ivc from anteriorly located subcardinal vein instead of supracardinal vein which are located posteriorly. Retrocaval ureter also referred to as circumcaval ureter or preureteral vena cava is a rare congenital anomaly with the ureters passing posterior. Here, ureter passes between the inferior vena cava ivc and psoas muscle and gets compressed. The objective of our study is to present our experience and discuss the safety and the feasibility of transperitoneal laparoscopic pyelopyelostomy for treatment of retrocaval ureter rcu.
Video segment showing the steps of robotic assisted reconstruction of the retrocaval ureter. Get a printable copy pdf file of the complete article 2. Renal calculi are also present, presumably due to stasis. Circumcaval ureterretrocaval ureter bmj case reports. At 3month postoperative consult, the patient presented symptomfree and a mag3 scan was performed showing no signs of obstruction. For the treatment of this condition, classical open pyeloplasty techniques had been the gold standard for many years. Urinalysis was negative for red blood cells, white blood cells, or protein. Retroperitoneoscopic treatment of a retrocaval ureter. Full blood count, urinalysis and blood urea and creatinine were normal. The images showed that the upper part of the right ureter was dilated and the portion lying. Laparoscopic transperitoneal repair of retrocaval ureter. Recently, a few studies have shown similar outcomes following surgery in which excision of the retrocaval segment was not done.
A 33yearold nondiabetic married woman from rural background presented with complaints of dull intermittent right flank pain since 1 year. Case 1 was a 20yearold woman who presented with symptoms of a right ureter stone. Retrocaval ureter is a rare congenital anomaly, with the ureter passing posterior to the inferior vena cava. Laparoscopic ureteroureterostomy for retrocaval ureter. Diagnosis and laparoscopic management of retrocaval ureter. Learningradiology retrocaval ureter, circumcaval ureter. Minimally invasive approach of a retrocaval ureter. The distal ureter was mobilized sufficiently to facilitate tensionfree ureteroureteral anastomosis, then the ureter was transected just above the retrocaval segment, which was then repositioned to lie anterior to the ivc. 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. A rare case of right retrocaval ureter with duplication of. The proximal ureter deviates medially passing behind the ivc and winding around it before crossing. Retrocaval ureter is a rare condition that results due to citation. Retrocaval ureter rcu is a rare congenital anomaly with the ureter looping around inferior vena cava ivc. In urography, the medial deviation of the right ureter in the rare circumstance in which it passes behind the inferior vena cava before entering the pelvis.
The main limiting factor for both a transabdominal and a retroperitoneal laparoscopic repair is the intracorporeal anastomosis of the ureter, which significantly increased the surgical time. The axial ct below shows the inferior ureter white arrow coursing posterior to the inferior vena cava red arrow. Pdf the aim of this study was to report our 23year experience in the diagnosis and treatment of retrocaval ureter. Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly which commonly presents with loin pain in middle age group. Both of these terms are somewhat misleading, as this configuration is considered a developmental anomaly of the ivc. She had no history of fever, dysuria, haematuria or weight loss. Ivc free of respiratory misregistration and motion artefacts, may produce overlapping images, and.
Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly. Retrocaval ureter is a rare congenital anomaly occurring with incidence of about 1 in 1500 people with a three to four times male predominance in autopsy studies. Ct scan below the level of the kidneys demonstrates a. The patient was treated with intravenous antibiotics and drainage of the right kidney by a double j stent with retrograde ureteropyelography that confirmed the diagnosis of retrocaval ureter, antibiotic treatment continued for 2 weeks orally, and laparoscopic repair of retrocaval ureter was planned after sterilization of the urine. Retrocaval ureter in a child with turners syndrome jama. Spiral ct, which can simultaneously outline the ureter and. Transperitoneal laparoscopic pyelopyelostomy for retrocaval. A case of retrocaval ureter associated with carcinoma of the renal pelvis has been presented.
Complete laboratory evaluation including urinalysis, complete blood picture, urea, creatinine and electrolytes were within. The hydronephrosis is due to kinking of the ureter. Duplication of ivc is another rare congenital anomaly in the development of ivc. 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. Retrocaval ureter a rare cause of hydronephrosis in children. A case series 7 and ureteroureteral or ureteropelvic reanastomosis. Diagnosis and treatment of the circumcaval ureter european. A 60yearold man presented with a 30year history of back pain which had worsened over 3 days.
Retrocaval ureter, also called circumcaval ureter or preureteral vena cava, is a rare congenital anomaly in which the ureter passes posterior to the inferior vena cava ivc. Retrocaval ureter and contra lateral renal agenesis a case. A retrocaval ureter is a congenital anomaly in which the ureter passes behind and is compressed by the inferior vena cava. The ureter is slightly dilated proximal to this point and returns to a normal position distal to its retrocaval placement. Laparoscopic ureteroureterostomy for retrocaval ureter european. It is nearly always single and located on the right side. Stone treatment by eswl was successful and the patient became stone free after 10 weeks. Campbell 5 stated in his 1963 textbook that about 90 cases had been reported to date, and the diagnosis was made preoperatively in 28. Interestingly, a laparoscopic pyelopyelostomy for retrocaval ureter without.
Pain on percussion of the right lumbar region was evident on physical examination. Retrocaval ureter rcu is a rare congenital anomaly in which the ureter passes posterior to the inferior vena cava ivc. Retrocaval ureter is a rare entity1 with a reported incidence of approximately 1 in 1100 and a 2. Retrocaval ureter is still a rare congenital anomaly. Laparoscopic ureterolysis and reconstruction of a retrocaval ureter. Medial deviation of the ureter should lead to a suspicion of a retrocaval ureter. Complete laboratory evaluation including urinalysis, complete blood picture, urea, creatinine and electrolytes. Although coarctation of the aorta is the anomaly most frequently thought of regarding visceral defects. Open surgery was the classic treatment for this condition. The retrocaval segment had a completely normal appearance on gross inspection in. The ureter is lined by urothelial cells, a type of transitional epithelium, and has an additional smooth muscle. A retrocaval ureter is a rare anomaly in children and needs a high index of suspicion to be detected early in life.
A male patient with retrocaval ureter and right renal calculus is reported. The hydronephrosis in patients with a retrocaval ureter is mainly described as a consequence of the compression by the psoas muscle, spinal column, and ivc on the anomalous ureter 24 x 24 xiaodong, z. Retrocaval ureter in a ferret di girolamo 2015 journal. The syndrome of gonadal dysgenesis, or turners syndrome, is essentially a combination of a chromosomal aberration, an endocrine disorder, and a number of congenital somatic malformations. Retroperitoneoscopic ureteroureterostomy for retrocaval ureter. Pdf laparoscopic ureterolysis and reconstruction of a. Case report minimally invasive approach of a retrocaval ureter. The retrocaval ureter is a rare congenital entity that causes external compression of the proximal ureter and usually becomes symptomatic in the third or fourth decade of life 1. Contrastenhanced ct and diuretic renography are the methods of choice to reveal the anatomy and function on the affected side. 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. 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. A retrocaval ureter, which is also called circumcaval ureter, is an abnorm development of vena cava and ureter. Coronal reformatted mips image from a ct urogram demonstrates medial displacement of the right ureter at the level of l3 white arrow. Contrastenhanced ct and diuretic renography are the methods of choice to. Retrocaval ureter is an uncommon clinical entity that generally causes upper urinary tract obstruction on the right side as the right ureter courses posterior to the inferior vena cava. Although it is a congenital anomaly, the patient presents later in life, from a resulting hydronephrosis. Clinical examination of the abdomen was within normal limits. Sep 06, 2014 laparoscopic surgery for retrocaval ureter performed at srmc pediatric urology workshop 1920 april 2014 by dr. Retrocaval ureter description, causes and risk factors. It has the advantage of being radiation free and of providing multiplanar images. So if you are looking to learn the latest surgical procedures or share your latest surgical knowledge, feel free to browse.
Bendre p, nage a, dsouza fh 2016 retrocaval ureter a rare cause of hydronephrosis in children. In the present study, relief of ureteric obstruction was achieved without excising the retrocaval segment. The patient was treated with intravenous antibiotics and drainage of the right kidney by a double j stent with retrograde ureteropyelography that confirmed the diagnosis of retrocaval ureter, antibiotic treatment continued for 2 weeks orally, and laparoscopic repair of retrocaval ureter. The prevalence of this condition is approximately 1 per 1,000 persons, with males 23 times more likely than. Laparoscopic surgery for retrocaval ureter performed at srmc pediatric urology workshop 1920 april 2014 by dr. Our patient had a stone impacted in the retrocaval portion of the ureter between the vena cava and the vertebra on ct scans, so we considered that neither endourological procedures nor extracorporeal shock wave lithotripsy would be easy to perform. Retrocaval ureter medigoo health medical tests and free. Retrocaval ureter is a rare cause of hydronephrosis. Retrocaval ureter is also known as circumcaval ureter. Mar 09, 2012 video segment showing the steps of robotic assisted reconstruction of the retrocaval ureter. Retrocaval ureter definition of retrocaval ureter by.
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 ureters are tubes made of smooth muscle fibers that propel urine from the kidneys to the urinary bladder. Retrocaval ureter is a rare anomaly due to an abnormal development. It is a term used to describe an abnormal course of a ureter that encircles the ivc. Mar 20, 2010 a 60yearold man presented with a 30year history of back pain which had worsened over 3 days. Robotic ureteroureterostomy of the retrocaval ureter without. This is the 2nd such case out of 110 cases reported in japan. Oct 29, 2016 retrocaval ureter is a rare congenital anomaly, with the ureter passing posterior to the inferior vena cava. Ivp and ct demonstrate partial obstruction of the right renal collecting system with a retrocaval ureter. Interestingly, a laparoscopic pyelopyelostomy for retrocaval ureter without resection of the retrocaval segment has been debated. The distal ureter was mobilized sufficiently to facilitate tension free ureteroureteral anastomosis, then the ureter was transected just above the retrocaval segment, which was then repositioned to lie anterior to the ivc. Retrocaval ureter is a congenital anatomy that requires surgical correction in symptomatic patients with ureteral obstruction.
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