Varied presentations of retrocaval ureter

Introduction: Retrocavalureter is a rare congenital venous anomaly in which ureter courses posterior to IVC .Incidence of Retrocavalureter - 1 in 1100 .There is a 2.8-fold male predominance .This vascular anomaly is not always associated with ureteral obstruction and degree of obstruction depends on type of Retrocaval ureter .surgical correction remains the method of choice in management of retrocaval ureter.
objective: To report the clinical presentation, radiological features and treatment of ten cases of retrocaval ureter managed in our institution from 2014-18.
Materials and methods: Imaging done in all the cases-IVU or retrograde pyelogram had been used for confirming the diagnosis.hemogram,renal function test,urine culture, serology, ECG, Chest Xray were done.out of the ten patients 5 patients were symptomatic with right loin pain at the time of presentation and was investigated with renal function test and CT KUB and 2 patients were found to have secondary calculus and underwent surgery.
2 patient had nonspecific diffuse abdominal pain.on imaging found to be retro caval ureter. One patient had right side abdominal pain associated with cholelithiasis and liverfuction test is done apart from urology investigtions.2 patients were asymptomatic and routine USG found the disease.
Results: All 10 patients were male.Clinical presentation-Right loin pain(5/10)Ureteric calculus(2/10)Anuria (1/10)Urosepsis(1/10) Open Ureteroureterostomy were performed with resection of the stenotic segment of the ureter in all 10 cases . All of them underwent intraoperativeureteralstent (double J stent) insertion.One patient underwent cholecystectomy in the same sitting .One patient underwent URSL on the opposite sideOne patient underwent right PCN as urinary diversion for sepsis All of them had uneventful postoperative period. Ureteralstents were removed about 6-8 weeks later .Postoperatively loin pain and hydronephrosis were improved in all cases.
Conclusion: An accurate pre operative diagnosis of Retrocaval ureter can be achieved by imaging studies. The most common presentation is right loin pain. Surgical treatment needed for symtomatic patients.before definitive surgery associated renal function compromise, urinary infection should be addressed by appropriate methods like PCN,DJ stenting, antibiotics.