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Retro-Iliac Ureter: A Case Report
Vol. 107, January Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1972 by The Williams & Wilkins Co.
RETRO-ILIAC URETER: A CASE REPORT E. HOCK, A. PURKAYASTHA
AND
B. D. JAY
From Wilson Memorial Hospital, Johnson City, New York
Fm. 1. A, preoperative IVP. B, preoperative retrograde pyelogram
Retro-iliac ureter was reported as a new entity by Corbus and associates in 1960. 1 Later Schifino and Basso and Pacedziev described the entity. 2- 3 Our case is reported to direct attention to the existence of such a congenital anomaly. The similarity of its radiographic appearance to that of retrocaval ureter is obvious. The precise diagnosis in this case was not made preoperatively. CASE REPORT
A 73-year-old white woman was admitted to this hospital with a depressive reaction and was seen in surgical consultation for right flank pain. She had had intermittent attacks of such pain for many years. The pain was localized to the flank and sometimes associated with frequency and urgency but without hematuria. Physical examination revealed marked tenderness in the right costovertebral angle but was otherwise unremarkable. There was gross pyuria and urine culture revealed Escherichia coli. An excretory urogram (IVP) disclosed marked hydronephrosis with lateral looping of the upper portion of the right ureter proximal to obstruction at the 5th Accepted for publication December 1970. 1 Corbus, B. C., Estrem, R. D. and Hunt, W.: Retro-iliac ureter. J. Urol., 84: 67, 1960. 2 Schifino, A. and Basso, R.: Uretere retroiliaco. (Descrizione di un caso). Radiol. Med., 60: 632, 1964. 3 Pacedziev, L.: Retroiliac ureter. Folia Med., 9: 319, 1967.
Fm. 2. Postoperative IVP
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HOCK, PURKAYASTHA AND JAY
lumbar vertebra approximately 5 cm. from the midline (fig. 1, A). The findings were confirmed by retrograde pyelography (fig. 1, B). Diagnosis of retrocaval ureter was entertained although it was believed that the site of obstruction was probably too far lateral and was below the level of bifurcation of the vena cava. On June 16, 1970 the right kidney and ureter were explored through a low-lying lumbar incision. The markedly dilated ureter was dissected and traced downward to the point at which it passed behind the right common iliac artery and vein approximately 3 cm. below the commencement of the vena cava. Dilatation ended at this point. The ureter was dissected free above and below the iliac vessels and was divided transversely. Continuity was restored by end-to-end
anastomosis over a uretera] catheter. The wound was closed in layers and a small Penrose drain was left indwelling. Convalescence was uneventful. The drain was removed 3 days postoperatively and the ureteral catheter was removed 10 days postoperatively. An IVP 15 days postoperatively revealed marked diminution in the degree of hydronephrosis although the ureter remained appreciably dilated (fig. 2). The patient has been clinically free of flank pain and urinary symptoms. SUMMARY
A case of retro-iliac ureter in a 73-year-old woman is reported. Gross similarity of its pye]ographic appearance to retrocaval ureter is noted.
THE JOURNAL OF UROLOGY
Copyright © 1972 by The Williams & Wilkins Co.
RETRO-ILIAC URETER: A CASE REPORT E. HOCK, A. PURKAYASTHA
AND
B. D. JAY
From Wilson Memorial Hospital, Johnson City, New York
Fm. 1. A, preoperative IVP. B, preoperative retrograde pyelogram
Retro-iliac ureter was reported as a new entity by Corbus and associates in 1960. 1 Later Schifino and Basso and Pacedziev described the entity. 2- 3 Our case is reported to direct attention to the existence of such a congenital anomaly. The similarity of its radiographic appearance to that of retrocaval ureter is obvious. The precise diagnosis in this case was not made preoperatively. CASE REPORT
A 73-year-old white woman was admitted to this hospital with a depressive reaction and was seen in surgical consultation for right flank pain. She had had intermittent attacks of such pain for many years. The pain was localized to the flank and sometimes associated with frequency and urgency but without hematuria. Physical examination revealed marked tenderness in the right costovertebral angle but was otherwise unremarkable. There was gross pyuria and urine culture revealed Escherichia coli. An excretory urogram (IVP) disclosed marked hydronephrosis with lateral looping of the upper portion of the right ureter proximal to obstruction at the 5th Accepted for publication December 1970. 1 Corbus, B. C., Estrem, R. D. and Hunt, W.: Retro-iliac ureter. J. Urol., 84: 67, 1960. 2 Schifino, A. and Basso, R.: Uretere retroiliaco. (Descrizione di un caso). Radiol. Med., 60: 632, 1964. 3 Pacedziev, L.: Retroiliac ureter. Folia Med., 9: 319, 1967.
Fm. 2. Postoperative IVP
37
38
HOCK, PURKAYASTHA AND JAY
lumbar vertebra approximately 5 cm. from the midline (fig. 1, A). The findings were confirmed by retrograde pyelography (fig. 1, B). Diagnosis of retrocaval ureter was entertained although it was believed that the site of obstruction was probably too far lateral and was below the level of bifurcation of the vena cava. On June 16, 1970 the right kidney and ureter were explored through a low-lying lumbar incision. The markedly dilated ureter was dissected and traced downward to the point at which it passed behind the right common iliac artery and vein approximately 3 cm. below the commencement of the vena cava. Dilatation ended at this point. The ureter was dissected free above and below the iliac vessels and was divided transversely. Continuity was restored by end-to-end
anastomosis over a uretera] catheter. The wound was closed in layers and a small Penrose drain was left indwelling. Convalescence was uneventful. The drain was removed 3 days postoperatively and the ureteral catheter was removed 10 days postoperatively. An IVP 15 days postoperatively revealed marked diminution in the degree of hydronephrosis although the ureter remained appreciably dilated (fig. 2). The patient has been clinically free of flank pain and urinary symptoms. SUMMARY
A case of retro-iliac ureter in a 73-year-old woman is reported. Gross similarity of its pye]ographic appearance to retrocaval ureter is noted.