A Rare Cause of Hydronephrosis: Retrocaval ureter

Abstract

Retrocaval ureter is a rare congenital anomaly that can cause hydroureteronephrosis. The right ureter winds posterior to the inferior vena cava and then continues to cours anteriorly due to abnormal embryogenesis of vena cava. Retrocaval ureter is seen mostly on the right side except patients with situs inversus. Although retrocaval ureter is a congenital disease, patients become symptomatic during the third or fourth decade of their lives. Flank pain, hematuria, upper tract urinary infections and urolithiasis are the symptoms can be seen. Ultrasound can show the dilation of the kidney but it is far from accurate diagnosis. Retrocaval ureter is diagnosed with intravenous pyelography (IVP), computed tomography urography (CTU) and magnetic resonance urography (MRU). Mild hydronephrosis with good excretory times can be followed without surgical intervention. But severe hydronephrosis with symptoms should be corrected with surgery. The surgical treatment involves excision of the retrocaval part of the ureter then bringing it anterior to the vena cava followed by ureteroureteral or ureteropelvic anastomosis. Open, laparoscopic and robotic surgeries are the different treatment modalities. Transperitoneal and retroperitoneal approaches are different options for the surgery. In this paper we report a retrocaval ureter case managed with laparoscopic ureteroureterostomy.