Retrocaval ureter case analysis and literature review

Retrocaval ureter, also called anteureteral vena cava, is rare disease caused by a maldevelopment of the inferior vena cava. This abnormality leads to varying degrees of ureteral compression which can result in gradual development of hydronephrosis and dilatation of the proximal ureter. Early diagnosis and treatment are important to salvage remaining renal function before extreme renal deterioration occur. Two types of retrocaval ureter were distinguished on the basis of radiographic criteria. Type 1 (low loop), the more common form, has an S or fish hook deformity at the point of obstruction. Type 2 (high loop) is noted to be sickle-shaped or inverted J-shaped at the level of the obstruction. From 1978 to 1995, 14 patients (mean age 42 years, range 14-52; male/female ratio 3.6:1) were diagnosed with retrocaval ureter preoperatively at our institution. The diagnostic procedures included intravenous pyelography, retrograde phelography, inferior venocavography and CT scan with ureteral catheterization. The type 1 retrocaval ureter involved 11 cases and type 2, 3 cases. The 14 cases included 2 nonoperative patients. Eight cases were diagnosed by CT scan with ureteral catheterization, and 6 by inferior venocavography. Operative procedures were performed in 12 patients, including Anderson-Hynes operation in 4 (including two cases with stone formation), transection of ureter at the retrocaval level and uretero-ureteric anastomosis in 5 and segmental resection of stenotic ureter behind the vana cava and end-to-end anastomosis in 3. The two non-operative patients were type 2, and were periodically followed up with renal function tests and diuretic renal scans. During follow up, no complications were noted. The mean follow up was 2 years. The advancement of imaging studies afford more convenience for urologists and patients, as many diseases can now be easily diagnosed pre-operatively rather than post-operatively as in the past. Early detection and rapid, appropriate treatment can be applied only when physicians highly suspect the possibility of disease. Early detection and treatment are essential to remedy a disease such as retrocaval ureter.