Dr. med. Dirk Manski



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Retrocaval Ureter

Definition of Retrocaval Ureter

A retrocaval ureter, which is also called circumcaval ureter, is an abnorm development of Vena cava and ureter. Due to the persistence of the right subcardinal vein in the lumbar area, the vena cava develops ventral of the right ureter (Zhang et al, 1990).

Epidemiology of Retrocaval Ureter

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Etiology of Retrocaval Ureter

The ureter lies between the following fetal veins: dorsally the supracardinal vein and posterior cardinal vein, ventrally the subcardinal vein. Normally, the portion kaudal of the renal vein of the inferior vena cava develops from the right supracardinal vein and the ureter lies anterior to the inferior vena cava. If the subcardinal vein persists, the inferior vena cava develops ventral of the ureter and may cause hydronephrosis by compression between vena cava and spine.

Signs and Symptoms

Diagnostic Work-Up

Intravenous urography:

The right mid ureter makes a sudden turn to the medial, there may also be a change in diameter. Caudally from the ureter kinking, there is often no contrasting of the ureter. Thus, the ureter looks like a "J". Signs of hydronephrosis or nephrolithiasis may be present.

Retrograde pyelography:

Spiral (S-shaped) curve of the ureter around the vena cava is visible [fig. retrocaval ureter].

Computed tomography or MRI:

The abnormal position of the ureter in relation to the inferior vena cava is easily visible.


fig. retrocaval ureter in retrograde pyelography

Retrocaval ureter: spiral or S-shaped curve of the ureter around the inferior vena cava with significant hydronephrosis. With kind permission of Prof. Dr. R. Harzmann, Augsburg.


Treatment of Retrocaval Ureter

Surgical treatment is necessary in complications, such as intermittent flank pain, nephrolithiasis, recurrent infections or significant hydronephrosis with loss of kidney function. Surgery consists of the division of the ureter after complete mobilisation, spatulation of the ureteral ends, and reanastomosis ventral of the vena cava (ureteroureterostomy). The technical difficulty of the operation is the necessity of extensive dissection of adhesions between ureter and vena cava with the corresponding risk of injury and bleeding. If the fibrotic adhesions between the ureter and vena cava are severe, the atretic ureter segment can be left behind the vena cava. Open surgery requires a relatively large retroperitoneal or transperitoneal access to the vena cava due to the central position within the abdominal cavity. Laparoscopy can significantly reduce the morbidity of the surgical access







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References

Zhang, X. D.; Hou, S. K.; Zhu, J. H.; Wang, X. F.; Meng, G. D. & Qu, X. K.
Diagnosis and treatment of retrocaval ureter.
Eur Urol, 1990, 18, 207-210


  Deutsche Version: Retrokavaler Ureter