Retrocaval Ureter: A Clinical Review of 7 Cases

Hong, Ji Hyun; Yoon, Jai Young; Hwang, Tae Kon; Cho, Dae Haeng; Park, Yong Hyun

Abstract

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.