RETROCAVAL URETER

Lt Col Hafiz
Etiology and Diagnosis
 Rare congenital urologic anomaly
 ‘Circum-caval ureter’ or a ‘Postcaval ureter’
 Embryologically abnormal IVC
 Presents on 3rd and 4th decades of life
 Almost invariably involves the right side, but when it
is reported on the left side, it is usually associated
with either a partial or a complete situs inversus or a D-
IVC
Etiology and Diagnosis
Etiology and Diagnosis
 At 4 weeks of life, 3
distinct venous systems
form:
 The vitelline system drains
the gut
 Umbilical system drains
the placenta, and
 The cardinal system drains
the rest of the embryo
Etiology and Diagnosis
 The infrahepatic IVC
develops from a set of 3
paired parallel veins
appearing consecutively
between 4 and 8 weeks of
life,
 Posterior cardinal veins
(brown),
 Subcardinal veins (green),
and
 Supracardinal veins (blue).
Etiology and Diagnosis
 Suprahepatic IVC (red)
originates from the vitelline
venous system
 Suprarenal/infrahepatic IVC
(green) originates from the
subcardinal venous system
 Infrarenal IVC (brown)
originates from the
supracardinal venous system
 Iliac veins and their
confluence (purple) originate
from the posterior cardinal
system.
Etiology and Diagnosis
 Abnormal persistence of the right subcardinal vein
positioned ventral to the ureter in the definitive IVC, as a
result of which the developing right ureter courses behind
and medial to the IVC

 On urography-
 S-shaped deformity on intravenous or retrograde
pyelography
 Definitive diagnosis can be made noninvasively using 3D
CT imaging
Etiology and Diagnosis
Etiology and Diagnosis
Etiology and Diagnosis
Operative Intervention
 The standard repair of retrocaval ureter is surgical pyelo-
pyelostomy.
 The ureter, dilated renal pelvis, and inferior vena cava are
identified and dissected using the standard open surgical
techniques.
 The dilated renal pelvis is then transected, after which the
ureter is transposed to its normal anatomic position
anterior to the vena cava
Operative Intervention
Conclusion
 Retrocaval ureter has been managed successfully with the
laparoscopic approach in the clinical setting as shown by a
series of sporadic cases.
 Managed successfully with the robotic-assisted
laparoscopic approach
 Clinical results with laparoscopic/robotic repair have been
favorable, indicating minimal postoperative patient
morbidity, short convalescence, and anastomotic patency
on short-term radiographic follow-up.