A Case of Retrograde Treatment of a Ureteral Stone in a Retrocaval Ureter

Abstract

Background: Retrocaval ureter is a rare entity with a reported incidence of ∼1 in 1100 and a 2.8-fold male predominance. The course of the ureter could be classified, using an intravenous urography, as type 1 having S-shaped, fish-hook, or J-shaped retrocaval course or type 2 having sickle-shaped course. No case report describing retrograde endoscopic management of ureteral calculi in the presence of retrocaval ureter could be found in existing literature. We are presenting a case of type I retrocaval ureter with ureteral calculi and nonobstructive drainage, which was effectively managed by flexible ureteroscopy.Case Presentation: A 62-year-old Caucasian man presented with complaints of a renal colic. The patient was positive for a history of noninsulin-dependent diabetes and hypertension. A direct abdomen CT scan showed an 8 mm ureteral stone with suspected retrocaval course of right proximal ureter with no hydronephrosis. After informed consent, ureteroscopy was performed on the patient's right proximal ureter. No complications occurred intraoperatively and postoperatively. On follow-up of up to 3 months, patient was asymptomatic and direct abdomen CT scan showed normal kidney without hydronephrosis.Conclusion: In the presence of retrocaval ureter and associated ureteral calculi with a condition of nonobstructive drainage, retrograde ureteroscopy is a safe and optimal procedure.

Congenital venous anomalies associated with retrocaval ureter: evaluation using computed tomography

“…Some patients had abdominal pain and haematuria due to hydronephrosis or urinary infection [1,9,13,14,16]. Associated urolithiasis and ureteral cancer were reported [8,19,25]. Surgical management is needed when the patient is symptomatic with documented subrenal functional obstruction [1,8,13,16,19,25].…”

“…Associated urolithiasis and ureteral cancer were reported [8,19,25]. Surgical management is needed when the patient is symptomatic with documented subrenal functional obstruction [1,8,13,16,19,25]. Surgical treatment should be performed as soon as possible when severe hydronephrosis is present and the upper ureter exhibits obvious dilation that affects the function of the kidney [9].…”

A combination of laparoscopic ureteroplasty and flexible uteroscopic lithotripsy in the treatment of circumcaval ureter and right renal calculi: A case report

“…Only several reports described a surgery in patients with CU complicated by kidney stones, but only renal calculi were treated rather than CU or both. 4 , 5 …”

Epidural analgesia for the treatment of colic attack with retrocaval ureter in late pregnancy complicated with marginal placenta previa: a case report

“…Some cases may be accidentally discovered in childhood during urological surgery [3] and when other congenital diseases [4] are present. The IVC compresses the ureter posteriorly, causing upstream dilatation of the proximal ureter and the kidney, resulting in flank pain, hematuria, pyelonephephritis, and urolithias [5]. It is a rare disease, with 2.8 to 3.0 times greater predominance [1,3,5] in males.…”

“…The IVC compresses the ureter posteriorly, causing upstream dilatation of the proximal ureter and the kidney, resulting in flank pain, hematuria, pyelonephephritis, and urolithias [5]. It is a rare disease, with 2.8 to 3.0 times greater predominance [1,3,5] in males. Thus, reports of retrocaval ureters in pregnant women are extremely rare.…”