Testing typically involves ultrasonography of the kidneys, ureters, and bladder before and after voiding, and then fluoroscopic voiding cystourethrography. A 14 year old male presented with a three months history of right flank pain that was of sudden onset and initially colicky but had become constant. Contrastenhanced ct and diuretic renography are the methods of choice to. Type i low loop is the most common, with the dilated proximal ureter assuming the shape of a reverse j. We present a case of retrocaval ureter and its mr appearances. Urinary system study guide by kdrathbone22 includes 62 questions covering vocabulary, terms and more. The erlangen experience exemplified by two case reports. In type 1 retrocaval ureter low loop, the dilated upper ureter is seen to descend from the renal pelvis and then curve upward and medially forming a reversed j appearance on ivp. Inflammation of a ureter is usually due to the upward spread of infection in cystitis.
Ureteric stone is noted at the middle segment of the right ureter below the level of ivc crossing, at the level of lower border of lv4 vertebral body with soft tissue rim sign representing the edematous ureteric wall. The authors report a case of retrocaval ureter in a male patient whose symptoms. The uterovesical junction uvj describes the short segment of ureter that courses through the muscular bladder wall, often protruding slightly into the bladder at the trigone fig. It is the most common renal abnormality, occurring in approximately 1% of the population. The intraoperative findings confirmed the diagnosis of right retrocaval ureter and associated hydronephrosis.
Full blood count, urinalysis and blood urea and creatinine were normal. Full text full text is available as a scanned copy of the original print version. Removal of the affected renal segment and ureter may be preferable to obstruction repair if no segmental renal function is found or if significant renal dysplasia is suspected. The ureter classically course medially behind the inferior vena cava winding around it and then passes laterally in front of it to then course distally to the bladder. Ureteral anomalies should be suspected in children with an episode of pyelonephritis or recurrent urinary tract infections. Like the bladder, it is lined with transitional epithelium, and contains layers of smooth muscle. Ureteral stricture often requires complex reconstruction to restore the ureter to its normal drainage. The findings on iv urography are correlated with the mri findings. Mullen and engel state that 55 cases have been reported.
Get a printable copy pdf file of the complete article 2. The epithelial cells of the ureter are stratified in many layers, are normally round in shape but become squamous flat when stretched. B several centimeters more caudally, the right ureter is again noted to be opacified. The most common malformations are, amongst other things, ureteroceles, ureter orifice narrowings, and ureterectopies.
During fetal life there are three venous channels composed of the postcardinal, subcardinal, and supracardinal veins. December 2011 volume 45, number 4 ghana medical journal 179 the ureter typically deviates medially behind the inferior vena cava, winding about and crossing in front of it. The ureter is the tube that drains urine from the kidney down to the bladder. Erlanger erfahrungen am beispiel zweier kasuistiken.
However, we believe mri is likely to replace ct in the diagnosis of retrocaval. We present a case of a 49yearold male who presented with loin pain and upon. The diagnosis was made roentgenographically on the basis of the sshaped course of. The prevalence of this condition is approximately 1 per 1,000 persons, with males 23 times more likely than females to develop the condition. Retrocaval ureter also referred to as circumcaval ureter or preureteral vena cava is a rare congenital anomaly with the ureters passing posterior to the inferior vena cava.
Abstract ureteroscopy is defined as upper urinary tract endoscopy performed most commonly with an endoscope passed through the urethra, bladder, and then directly into the upper urinary tract. Both of these terms are somewhat misleading, as this configuration is considered a developmental anomaly of the inferior vena cava ivc. Circumcaval ureter is a rare congenital anomaly with the ureter passing posterior to ivc, usually associated with hydronephrosis, results from anomalous development of the ivc and requires surgery in symptomatic cases. Here, ureter passes between the inferior vena cava ivc and psoas muscle and gets compressed. The procedure carried out involved dividing the ureter at. Type i low loop is the most common, with the dilated proximal ureter assuming the shape of a. In children, any ureter greater than 7 mm in diameter is considered a megaureter based on measurements in fetuses greater than 30 weeks gestation and children pdf file of the complete article 2. Urinalysis was negative for red blood cells, white blood cells, or protein. Endometriose mit ureterbeteiligung erlanger erfahrungen opus 4. 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 retrocaval ureter, which is also called circumcaval ureter, is an abnorm development of vena cava and ureter.
A retrocaval ureter is a rare anomaly in children and needs a high index of suspicion to be detected early in life. In some conditions, a portion of the ureter can be narrowed, which is called a stricture. Retrocaval ureter is a relatively rare anomaly that usually manifests in the third or fourth decades. Retrocaval ureter medigoo health medical tests and. Symptoms are due to ureteric obstruction, either extrinsic by the abnormal inferior vena cava. Retrocaval ureter is still a rare congenital anomaly. Ureter, urethra, urinary bladder the urogenital system. Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly which commonly presents with loin pain in middle age group. This constellation of symptoms and signs is highly suggestive of a retroperitoneal process with systemic.
Megaureter is defined as a ureter that exceeds the upper limits of normal size. Gladstones case, that of an acardiac monster, is the only example on record to date. The bladder narrows like a funnel into the bladder neck. Duplication of ivc is another rare congenital anomaly in the development of ivc. December 2011 volume 45, number 4 ghana medical journal. Retrocaval ureter definition of retrocaval ureter by. Unenhanced ct is the imaging method of choice for evaluating patients with acute flank pain and suspected ureteral obstruction. A preureteric vena cava, also known as a retrocaval ureter, is a rare congenital malformation of the right human ureter, in which the ureter passes behind the inferior vena cava, causing compression possibly leading to hydronephrosis. Links to pubmed are also available for selected references. This can be congenital, or the result of scarring from previous surgery, urinary stones, or other causes. In 1982, bergman classified retrocaval ureter into two clinical types8. Contrastenhanced ct and diuretic renography are the methods of choice to reveal the anatomy and function on the affected side. Persistence of both ventral and dorsal limbs will result in the ureter passing between the cavae. Retroiliac ureter definition of retroiliac ureter by.
Diagnosis 256 double urethra and accessory urethra 257 incomplete dorsal accessory urethrablind 258 incomplete dorsal accessory urethracommunicating with the urethra 259 etiology and pathology 261 clinical presentation 268 diagnosis 270 treatment. The ureter, instead of passing lateral to the vena cava, passes behind it, partially encircles it for a short distance, and then pursues its normal course ventral to the vena cava, downward into the bony pelvis and thence to the bladder. The interureteric ridge is a promontory on the posterior bladder wall between where the ureters enter the bladder. Sep 06, 2014 laparoscopic surgery for retrocaval ureter performed at srmc pediatric urology workshop 1920 april 2014 by dr.
C coronal, excretoryphase, volume rendered image reveals that a large portion of the left ureter was not opacified during image acquisition. Retrocaval ureter can be classified into 2 types based on radiologic appearance. Pain on percussion of the right lumbar region was evident on physical examination. Its etiology is assumed to be abnormal embryologic development of the inferior vena cava as a result of atrophy failure of the right subcardinal vein in the lumbar portion. Retrocaval ureter 178 the patient had an open surgery through a midline abdominal incision. Like the bladder, it is lined with transitional epithelium, and contains layers of smooth muscle the epithelial cells of the ureter are stratified in many layers, are normally round in shape but become squamous flat when stretched. Circumcaval ureter, also known as retrocaval ureter, is a term used to describe an abnormal course of a ureter that encircles the inferior vena cava. Retrocaval ureter is a rare anomaly due to an abnormal development.
Learningradiology retrocaval ureter, circumcaval ureter. A 60yearold man presented with a 30year history of back pain which had worsened over 3 days. Retrocaval ureter medigoo health medical tests and free. Biopsies of the renal pelvis and ureter junction were negative. The retrocaval ureter is a congenital malformation that leads to a symptomatology related to obstructive uropathy. Ureteral anomalies msd manual professional edition. Retrocaval ureter can be associated with turners syndrome.
If there was small lesions he was going to lazer them but there was a large area of cis so he closed me up, sent me back to my urooncologist. The lumen of the prostatic urethra is lined with the same type. The ureter has a diameter of about 3 millimeters, and the lumen is starshaped. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Mar 20, 2010 a 60yearold man presented with a 30year history of back pain which had worsened over 3 days. Start studying congenital malformations of the ureter and kidney. Normal abdominal ivc that lies medial to the ureter is formed. Duplicated ureter or duplex collecting system is a congenital condition in which the ureteric bud, the embryological origin of the ureter, splits or arises twice, resulting in two ureters draining a single kidney. Congenital malformations of the ureter and kidney questions. Ivp and ct demonstrate partial obstruction of the right renal collecting system with a retrocaval ureter.
The images showed that the upper part of the right ureter was dilated and the portion lying. Quizlet flashcards, activities and games help you improve your grades. In 1893, hochstetter first described retrocaval ureter. Retrocaval circumcaval ureter associated with solitary. The ureter appears narrowed by extrinsic compression on the retrograde ureteropyelogram.
The images showed that the upper part of the right ureter was dilated and the portion. When a ureterocele involves the upper pole of duplex ureters, treatment depends on function in that renal segment, because of the significant incidence of renal dysplasia. Ucsf department of urology ureteral stricture obstruction. There is so much on this ct i dont understand impression reads unfortunately there is limited contrast pacification of the caliber right distal ureter.
Retrocaval ureter has been previously diagnosed by ivu and rgp, but nowadays, ct scan is the best modality for diagnosis 5. 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. Ct scan below the level of the kidneys demonstrates a more medial retrocaval placement of the right ureter. Retrograde pyelogram of the type i variant shows an sshaped outline. Below the bladder neck, the prostatic urethra appears almost as an elongated teardrop with a posterior impression representing the verumontanum. The ureter is slightly dilated proximal to this point and returns to a normal position distal to its retrocaval placement. Renal calculi are also present, presumably due to stasis. So far ct has been the procedure of choice to confirm the diagnosis of retrocaval ureter. Laparoscopic surgery for retrocaval ureter performed at srmc pediatric urology workshop 1920 april 2014 by dr. Retrocaval ureter a rare cause of hydronephrosis in children. What does it mean ureter is unopacified on ct urogram.
The prevalence of this condition is approximately 1 per 1,000 persons, with males 23 times more likely than. Ureteral anomalies pediatrics msd manual professional edition. Jan 30, 2020 the manifested inflammations can again cause a malakoplakia greywhitish plaque at the ureter wall or a urerteritis cystica. Pitfalls in image interpretation urinary tract collecting. Four types of retrocaval ureter have been observed in man. Role of ureteroscoy and retrograde studies of the ureter in. The manifested inflammations can again cause a malakoplakia greywhitish plaque at the ureter wall or a urerteritis cystica. A rare case of right retrocaval ureter with duplication of. I was then sent to an endourologist for biopsies of the ureter. Treatment and prognosis if treatment is required, surgical relocation of the ureter anterior to the ivc can be performed. A retrocaval ureter is a congenital anomaly in which the ureter passes behind and is compressed by the inferior vena cava.
Medial deviation of the ureter should lead to a suspicion of a retrocaval ureter. Elimination of the need for iv contrast material and the speed at which a scan can be obtained have given ct unique advantages over older imaging methods such as excretory urography and sonography. Ureteral anomalies merck manuals professional edition. Apr 18, 2011 biopsies of the renal pelvis and ureter junction were negative. Role of ureteroscoy and retrograde studies of the ureter in diagnosis and treatment of ureteric pathology.
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