Retrocaval Ureter

Retrocaval Ureter is still a rare congenital anomaly. Campbell (5) stated in his 1963 textbook that about 90 cases had been reported to date, and the diagnosis was made preoperatively in 28. A review of the recent literature, however, shows that the number of reported cases is now at least 100. The purpose of the present paper is to describe a case in which the diagnosis was made following intravenous and retrograde pyelography. Case History The patient, a 55-year-old white woman, married, with two children, was admitted to Ross Memorial Hospital, Lindsay, Ont., March 16, 1964, with a diagnosis of pyelonephritis. The patient's chief complaint was pain on the right side of the abdomen occurring typically late in the day. On physical examination tenderness in the right lower quadrant and right costovertebral angle was noted. Intravenous pyelography on March 17 revealed blunting of the calyces on the right side along with a little dilatation (Fig. 1). Tortuosity of the upper portion of the right ureter was disclosed, more noticeable when the patient was upright. The ureter appeared to follow a peculiar course, and retrograde pyelography was recommended. Retrograde pyelography was performed March 19 (Figs. 2 and :3). A moderate pyelocaliectasis of the right kidney was noted, and the catheter was seen to pass toward the midline, overlying the vertebral column in the region of the third and fourth lumbar vertebrae. After withdrawal of the catheter the right collecting system remained dilated with only the upper third of the ureter filled with contrast material. On the basis of these findings the diagnosis of retrocaval ureter was made. At surgery the ureter was found to pass downward behind the vena cava, then partially encircle it. As the ureter proceeded toward the bladder, it lay ventral to the vena cava. The ureter was divided near the kidney, replaced in its normal position, and reanastomosis was carried out. Follow-up intravenous pyelography on May 7 (Fig. 4) disclosed some residual hydronephrosis, tortuosity of the mid portion of the right ureter, and a little narrowing at the site of the anastomosis. Clinical examination on June 15 showed the patient to be symptom-free. Incidence, sex, age, and side involved Retrocaval ureter may occur at any age and in either sex, although Abeshouse and Tankin (1) in reviewing 58 cases counted 38 males. Many of these were found in the dissecting room, however, where most bodies were male. Both Jacobson and Hofstetter describe cases in infants of one year (5) and Gladstone discovered the anomaly in an 84-year-old man at autopsy. The condition is almost invariably limited to the right side, but a case of left-sided retrocaval ureter associated with situs inversus has been reported by Brooks (4). Bilateral postcaval ureters in an acardiac fetus have also been reported.