Ureter circuncaval ­ diagnóstico pela tomografia computadorizada: relato de caso / Circuncaval ureter - diagnosis by computed tomography: case report

Contexto: O ureter circuncaval, também conhecido como pré-ureter ou ureter retrocaval, é uma rara anomalia congênita com a qual os pacientes raramente relatam sintomas até a terceira ou quarta décadas de vida. A anomalia envolve predominantemente o ureter direito. Um ureter retrocaval à esquerda é visto apenas com persistência da veia cardinal esquerda, com situs inversus completo ou duplicação da veia cava inferior. A compressão do ureter entre a veia cava inferior e as vértebras resulta em hidronefrose e ureteronefrose progressiva. Descrição do caso: Paciente do sexo masculino, 31 anos de idade, com dor lombar recorrente à direita há dois anos. Apresenta exame físico sem alterações evidentes, inclusive testes específicos para a coluna vertebral. Exame de tomografia computadorizada da coluna lombar realizada há 18 meses, sem alterações significativas. Discussão: O ureter circuncaval, na maioria dos casos, é assintomático. Os sintomas dependem do grau de obstrução ureteral ou da presença de complicações e consistem em dor no flanco ­ ocasionalmente a dor intermitente é a primeira queixa ­, infecções recorrentes do trato urinário, hematúria macroscópica ou microscópica. Deve ser levado em conta que o ureter retrocaval pode coexistir com outras anomalias congênitas ­ 20% dos pacientes com ureter retrocaval apresentam anomalias congênitas concomitantes. O procedimento cirúrgico geralmente consiste na divisão ureteral, ressecção do ureter estenótico e redundante com realocação e reanastomose ureteroureteral ou ureteropélvica. Conclusão: Relatamos um caso de ureter circuncaval que é uma rara anomalia congênita predominantemente

Type II retrocaval ureter causing hydronephrosis in a cat: case report / Ureter retrocava tipo II causando hidronefrose em um gato: relato de caso

Retrocaval ureter (RU) is an abnormal embryonic development of the caudal vena cava (CVC) that leads the ureter to be entrapped dorsal to the CVC. In most cases there is no clinical impact; however, it can cause hydronephrosis. We report a rare case of type II symptomatic retrocaval ureter in a feline treated with nephroureterectomy. A 4-year-old, intact male, mixed breed cat was submitted to abdominal ultrasound and severe right hydronephrosis was diagnosed, with no signs of obstruction. We performed an exploratory celiotomy, in which a displacement of the right ureter dorsal to the CVC was observed. The animal was treated with ureteronephrectomy and recovered well. No intraluminal cause was found, and a urethral catheter could be easily inserted across the ureter length. The real clinical relevance of the RU is unknown, since it is a common find in post-mortem examination without kidney impact and, when significant, is often associated to other causes of ureteral obstructions, such as calculi and strictures. Additionally, in humans, type II RU seldom develops obstruction and hydronephrosis. In our case, due to absence of other causes of obstruction, probably mechanical compression of the CVC against the psoas muscle caused the hydronephrosis.(AU)

O ureter retrocava (UR) é originado por uma falha na formação embriológica da veia cava caudal (VCC), que leva ao aprisionamento do ureter dorsal à VCC. Na maioria dos casos, não há impacto clínico; entretanto, essa anomalia pode causar hidronefrose. Relata-se um raro caso de UR tipo II sintomático em um felino, tratado com nefroureterectomia. O referido animal, sem raça definida, macho intacto de quatro anos de idade, foi submetido à ultrassonografia abdominal, que revelou acentuada hidronefrose direita, sem sinais de obstrução. Realizou-se celiotomia exploratória, na qual foi possível observar o ureter direito dorsal à VCC. O animal foi tratado com nefroureterectomia e se recuperou satisfatoriamente. Nenhuma causa intraluminal foi encontrada e um cateter uretral pôde ser facilmente inserido por todo o comprimento do ureter. A real relevância clínica do UR é desconhecida, visto que é um achado comum em exames post mortem, sem impacto aos rins e, quando significante, frequentemente está associado a outras causas de obstrução ureteral, como cálculos e estenoses. Adicionalmente, em humanos, o UR tipo II raramente desenvolve obstrução e hidronefrose. Neste caso, devido à ausência de outros motivos de obstrução, acredita-se que a compressão mecânica da VCC contra o músculo psoas foi a causa da hidronefrose.(AU)

Uréter retrocavo e infección recurrente de vías urinarias: A propósito de un caso / Retrocaval Ureter and Recurrent Urinary Tract Infection: Case Report

El uréter retrocavo es una anomalía poco frecuente de etiología congénita, la cual causa sintomatología en pacientes adultos; se caracteriza por hidronefrosis en diferentes grados, además de otras patologías relacionadas con lesión renal. El abordaje terapéutico es principalmente quirúrgico y se aplicará de acuerdo con el grado de disfunción renal. A continuación se presenta el caso de una mujer de 27 años de edad, a quien se le practicó un estudio imaginológico por infección recurrente de vías urinarias que no respondió a la farmacoterapia habitual.

Retrocaval ureter is a rare anomaly of congenital etiology, which causes symptoms in adults and is characterized by hydronephrosis in different degrees, in addition to other diseases related to renal injury. The therapeutic approach is mainly surgical and decided according to degree of related renal dysfunction. We present a case of a woman aged 27 who is sent to the radiology service of Hospital San Rafael Tunja for an imaging study after refractory urinary tract infection that did not respond to standard drug therapy

Retrocaval ureter and contra lateral renal agenesis – a case report and review of literature

ABSTRACT Associated congenital anomalies are seen in 21% of retrocaval ureter patients; among them, associated contralateral renal agenesis is a very rare entity. We report one such case of right circumcaval ureter with left renal agenesis, diagnosed after febrile UTI. Surgical correction with uretero-ureterostomy was successful. In literature very few such cases are reported and only one case with renal failure was reported. Unilateral renal agenesis cases complicated by associated such anomalies need definitive management and lifelong clinical monitoring to diagnose and prevent chronic kidney disease.

Right sided double inferior vena cava with obstructed retrocaval ureter: Managed with single incision multiple port laparoscopic technique using "Santosh Postgraduate Institute tacking ureteric fixation technique"

Right double inferior vena cava with obstructed retrocaval ureter is an extremely rare anomaly with only a few reported cases in the literature. To the best of our knowledge, this is the first case report describing ureteric repair by use of a single-incision laparoscopic technique. In addition, this report addresses the underlying surgical challenges of this repair and provides a brief review of the embryology of this anomaly. The "Santosh Postgraduate Institute ureteric tacking fixation technique" provides ease of end-to-end uretero-ureteric anastomosis in a single-incision laparoscopic surgery.

Retrocaval Ureter: Report of 2 Different Clinical Spectrums

Retrocaval ureter is a relatively rare anomaly where ureteric obstruction may occur as a result of ureter passes behind the inferior vena cava (IVC), hence, compressing it between the IVC and the vertebrae. We report 2 cases of retrocaval ureter with different presentations. One patient was managed surgically with minimally invasive approach and the other was managed conservatively.

Transperitoneal and retroperitoneal laparoscopic ureteroureterostomy for retrocaval ureter / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the results of transperitoneal and retroperitoneal laparoscopic ureteroureterostomy procedure in the treatment of patients with retrocaval ureter.</p><p><b>METHODS</b>From May 2004 to December 2012, 18 patients including 12 male and 6 female patients were operated for retrocaval ureter, the average age was (37 ± 10) years (range 17-55 years). Eight patients underwent transperitoneal laparoscopic ureteroureterostomy (transperitoneal laparoscopic group), and the other 10 patients' laparoscopic procedure were performed via retroperitoneal approach(retroperitoneal laparoscopic group). These patients' records were retrospectively analyzed for perioperative characteristics, complications and follow-up results. A two-tailed Student's t-test was used to compare perioperative data between the two groups.</p><p><b>RESULTS</b>Technical success was acquired in all 18 laparoscopic procedures. Mean operative time of transperitoneal and retroperitoneal laparoscopic group was (85 ± 20) minutes (60-130 minutes) and (98 ± 30) minutes (70-180 minutes) , respectively. There was no difference in operation time between the two groups (t = 1.03, P > 0.05). The blood loss was less than 50 ml in all the patients. Comparison of anal exhaust time between the two groups showed no statistic difference (t = 0.16, P > 0.05). No perioperative complication was observed. Intravenous pyelography or CT urography 3 months after the operation revealed a widely patent anastomosis with considerable improvement in hydronephrosis in all patients. There was no recurrence at a mean follow up of (40 ± 24) months (range 12-115 months).</p><p><b>CONCLUSION</b>Both transperitoneal and retroperitoneal laparoscopic ureteroureterostomy are effective and minimally invasive surgical alternative for the management of retrocaval ureter.</p>

The Initial Experience of Laparoscopic Ureteroureterostomy for Retrocaval Ureter / 대한비뇨기과학회지

Retrocaval ureter is a rare congenital anomaly that causes symptomatic hydronephrosis. Despite difficulties in the intracorporeal suturing, a retrocaval ureter is thought to be a good candidate for laparoscopic surgery, especially from the cosmesis. Laparoscopic ureteroureterostomy has advantages compared to conventional open surgery in terms of less pain, decreased blood loss, smaller operative wound and shorter hospital stay. Herein, we report our initial experience of laparoscopic ureteroureterostomy in a patient with a retrocaval ureter.

Right Hydronephrosis Caused by Congenital Circumcaval Ureter in a Spinal Cord Injured Patient: A case report

Circumcaval ureter is one of the congenital anomaly in which aberrant development of the inferior vena cava (IVC) causes compression of the deviated ureter medially behind the IVC. The incidence is approximately one in 1500 cadavers and is three to four times more common in male. Although the lesion is congenital, symptoms attributable to this anomaly usually appear in young adulthood. This is a case of 17-year-old spinal cord injured man with a circumcaval ureter who was diagnosed as right hydronephrosis by routine evaluation for neurogenic bladder, incidentally. Suprapubic cystostomy was done for prevention of further urologic complication and the severity of hydronephrosis was not aggravated in follow up studies after 6 months. We suggest early routine evaluation for neurogenic bladder is very important for prevention of developing urologic complication caused by congenital urologic anomaly in the patients with spinal cord injury.

A Case of Multiple Urothelial Cell Carcinoma in Retrocaval Ureter / 대한비뇨기과학회지

Retrocaval ureter is a congenital venous anomaly, in which the ureter passes behind and is compassed by inferior vena cava. We experienced a case of multiple urothelial cell carcinoma in retrocaval ureter in 68 years old male. He was treated with transurethral resection of bladder tumor and right nephroureterectomy with bladder cuff excision.

Nonobstructive Right Retrocaval Ureter Associated with Double Inferior Vena Cava / 대한비뇨기과학회지

Retrocaval ureter is a rare congenital anomaly. We experienced a case of retrocaval ureter with double inferior vena cava and with intermittent right flank pain in 54 years old female. We performed IVU, RGP, Venacavogram, MRI, and diuretic DTPA renal scan. MRI is the best single study to delineate the anatomy clearly and noninvasively. She was treated with conservative treatment.

Retrocaval Ureter: A Clinical Review of 7 Cases / 대한비뇨기과학회지

Retrocaval ureter is a congenital venous anomaly, in which the ureter passes behind and is compressed by inferior vena cava. We present 7 cases of retrocaval ureter who admitted to our hospital from March 1984 to February 1994. Age of patients ranged from 23 to 65 years, a mean 37 years. The anomaly occurred 3 in male and 4 cases in female. Initial symptoms included flank pain in 5(71%) and symptom-free in 2 cases(29%). The patients were classified into type I(low loop, 5 cases) and type II(high loop, 2 cases) by Kenawi's classification depending on the level of uretero-caval cross over. Of 5 cases of type I retrocaval ureter 4 were underwent spatulated end-to-end ureteral anastomosis with resection of retrocaval ureteral segment, 1 was underwent nephrectomy. 2 cases of type II were treated conservatively. All of cases underwent spatulated end-to-end ureteral anastomosis showed regression of hydronephrosis and satisfactory drainage of the kidney in postoperative IVU. The pathologic findings of the resected ureteral segments showed fibrosis and chronic inflammatory cell infiltration in 3 and normal findings in 2 cases in H & E stain. But in the trichrome stain, fibrous replacement of ureteral muscle layers were demonstrated in all of cases. Guideline for treatment of retrocaval ureter may be based on specific radiographic criteria Resection of the retrocaval segment and spatulated end-to-end anastomosis may be required in the cases of the type I retrocaval ureter.

Two Cases of Retrocaval Ureter / 대한비뇨기과학회지

Retrocaval ureter or circumcaval ureter is a congenital anomaly of vascular system commonly causing ureteric obstruction. We present a case of right retrocaval ureter with right renal stone in a 42 year old man and a case with right flank dull pain and hypertension in 40 year old female. They were treated with ureteral end to end anastomosis with double-J stent.

A Case of Retrocaval Ureter with Left Renal Agenesis / 대한비뇨기과학회지

Retrocaval ureter is a rare congenital anomaly of the urogenital organ originating from the venous maldevelopment. To our knowledge, retrocaval ureter with contralateral renal agenesis has not been reported in Korea. Recently, we experienced a case of retrocaval ureter with contralateral renal agenesis, and obtained a good result following ureteral resection with end-to-end anastomosis of the ureter.

Hepatic and postrenal segment anomalies of inferior vena cava

Postrenal segment anomalies of inferior vena cava such as bilateral inferior vena cava and left-sided inferiorvena cava can simulate lymphadenopathy on CT scan and these anomalous veins need consideration in retroperitonealoperations such as procedures for prevenetion of venous embolism, splenorenal shunt operation and aorticprosthetic repalcement. Retrocaval ureter is a rare cause of obstructive uropathy or medical deviation of ureter.We analysed 16 cases of postrenal segment anomalies daignosed by CT, vena cavography, retrograde pyelography andultrasonography including six rare positional anomalies at hepatic segment of inferior vena cava diagnosed bycardiac angiography. The results were as follows. 1. Postrenal segment anomalies were 6 cases of bilateral IVC, 8cases of left-sided IVC and 2 cases of retrocaval ureters. On CT scan, 3 cases of bilateral IVC and 4 cases ofleft-sided IVC were accompained by malignant tumors, but caval veins could be discriminated from enlarged nodesbecause of continuous tubular nature of vein on consecutive sections with homogeneous strong enhancement. Twocases of retrocaval ureters showed hydroureteronephrosis due to ureteral compression by IVC. 2. Hepatic segmentanomalies were 6 cases. Five cases of IVC on left side of vertebral crossed midline at live to enter right-sidedright atrium and one case of IVC on right side crossed midline to enter left-sided right atrium. Four cases ofcomplex cardiac anomalies, 4 cases of asplenia and 2 cases of situs ambigus were associates with these anomalies.

A Case of Retrocaval Ureter / 대한비뇨기과학회지

Retrocaval or postcaval ureter is a well-recognized venous congenital anomaly commonly causing ureteric obstruction. A 42 year-old male was admitted to Korea University Hospital because of right flank pain. The right AGP reveals the S-shaped coures of ureter and hydronephrosis. The ureteral and to end anastomosis was done with double J ureteral stent. Herein we present a case of retrocaval ureter with brief review of literatures.

A Case of Retrocaval Ureter / 대한비뇨기과학회지

This rare venous congenital anomaly has been diagnosed preoperatively in a 35-year-old female with complaint of the right flank pain. Herein a case of retrocaval ureter is presented with brief review of literatures.

Combined Retrocaval Ureter and Benign Testicular Tumor / 대한비뇨기과학회지

Retrocaval ureter is a rare venous congenital anomaly. We experienced a case of this anomaly, which combined with benign testicular tumor in 21 year old. man. I.V.P, vena cavogram and abdominal C.T were performed. Abdominal C.T was a precise and non-invasive method in the confirming of this anomaly, replacing the vena cavogram, if there remained the moderate degree of Rt. renal function. Now, we introduce the finding of abdominal C.T. in retrocaval ureter.

Combined Retrocaval Ureter and Benign Testicular Tumor / 대한비뇨기과학회지

Retrocaval ureter is a rare venous congenital anomaly. We experienced a case of this anomaly, which combined with benign testicular tumor in 21 year old. man. I.V.P, vena cavogram and abdominal C.T were performed. Abdominal C.T was a precise and non-invasive method in the confirming of this anomaly, replacing the vena cavogram, if there remained the moderate degree of Rt. renal function. Now, we introduce the finding of abdominal C.T. in retrocaval ureter.

Retrocaval Ureter: A Case Report / 대한비뇨기과학회지

Retrocaval ureter is a rare embryologic venous system anomaly of genitourinary tract and its essentially to the right side. We have reported diagnosed preoperatively in 41 years old male with complaints of intermittent right flank pain, with gross hematuria, urinary frequency, nocturia, tenesmus, and high fever. I.V.P. revealed delayed dye excretion on the right side with pyelocalyectasis and ureterectasis of upper ureter and stenotic portion beneath ureter was non visualization. R.G.P. revealed same as I.V.P. and right ureter was `sickle shape` course and its descent alonged over the right side of 4th and 5th lumbar vertebra column. On post operation 8th days, I.V.P. revealed slightly reduced of previous marked dilated right pelviocalyceal system with upper ureter and preoperative placed ureter was corrected to normal course.