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Circumcaval ureter.
JS Pandya, PP Shilotri, RR Satoskar
Department Of General Surgery, T.N. Medical College, Mumbai.
Correspondence Address:
J S Pandya
Department Of General Surgery, T.N. Medical College, Mumbai.
Abstract
We report a case of circumcaval ureter diagnosed preoperatively by «SQ»fish-hook«SQ» appearance on intravenous pyelogram. At surgery, patient was treated by «SQ»Anderson Hones«SQ» pyeloplasty leaving the retrocaval segment in-situ.
How to cite this article:
Pandya J S, Shilotri P P, Satoskar R R. Circumcaval ureter. J Postgrad Med 1998;44:19-20
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How to cite this URL:
Pandya J S, Shilotri P P, Satoskar R R. Circumcaval ureter. J Postgrad Med [serial online] 1998 [cited 2023 Jun 3 ];44:19-20
Available from: https://www.jpgmonline.com/text.asp?1998/44/1/19/385 |
Full Text
Circumcaval ureter is an uncommon congenital anomaly, usually presenting in adulthood. Assessment of the stenotic retrocaval portion and manoeuvrability of the proximal and distal segment determines the most suited surgical procedure in a given case.
A 25 years old male patient came with complaints of intermittent colic and dysuria. Ultrasonographic examination revealed right hydroureter and hydronephrosis with 1.8 cm calculus in upper ureter. Radiologist suspected circumcava1 ureter on intravenous urography (IVU) findings of inverted "J" or "Fish hook" appearance of pelvis and ureter [Figure:1]. During retrograde pyelography the ureteric catheter could not bypass the obstruction [Figure:2]. At operation, the renal parenchymal surface was normal. The proximal segment of the ureter was varicose. The retrocaval portion showed severe adhesions. It did not admit a 4F ureteric catheter. The distal ureter was normal. The ureter was severed from the renal pelvis, the calculus removed and Anderson Hynes pyeloplasty was performed with the distal segment leaving retrocaval segment in-situ.
The patient had a Type l form of retrocaval ureter[1]. It is apparent that the plan of the corrective procedure cannot be decided until the operative findings are known. In this case selection of the reconstructive procedure can be relied by ureteric calibration of the distal ureter to differentiate between stenotic and non stenotic obstructions[2]. In this patient, we could approximate the pelvic ureteric ends easily hence a dismembered pyeloplasty was performed. The retrocaval portion was not excised and left in-situ due to severe adhesions[3]. Division of the vena cave has been suggested but there is no reliable test to identify the secondary pathology in the ureter (stricture, calculus) hence not advised. Leaving a retrocaval segment in-situ has no adverse postoperative consequences.
References
| 1 |
Schlussel RN, Retik AB. Anomalies of the ureter in Walsh PC, Retik AB, Vaughan DE, Weir AJ, Editors. Campbell’s Urology. WB Saunders; 1997, pp 1850 1852. |
| 2 | Kumar S., Bhandari M. Selection of operative procedure for Circumcaval Ureter (Type 1). BJU 1984; 57:399 401. |
| 3 | Kenawi MM, Williams DI. Circumcaval ureter. A case report of four cases in children with a review of the literature and a new classification. Br J Urol 1976; 48:183 197.
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