PDF(Pubmed)
Abstract：
Retrocaval ureter (RCU), also known as pre-ureteral vena cava or circumcaval ureter, is a rare congenital anomaly caused by inferior vena cava (IVC) dysgenesis, leading to the right ureter coursing behind the IVC. RCU results in obstructive proximal hydroureteronephrosis, remaining asymptomatic until the third decade when hydronephrosis develops. Diagnosis relies on imaging modalities like intravenous urography (IVU), ultrasonography, computed tomography urography (CTU), magnetic resonance urography, and nuclear scintigraphy. CTU provides comprehensive 3D evaluation. We report a novel case of a 50-year-old male with RCU complicated by a concurrent distal ureteral calculus. CTU demonstrated the characteristic \"S-shaped\" proximal ureteral deformity and its aberrant posterior course relative to the IVC, enabling accurate preoperative diagnosis. The co-occurrence of RCU with ureteral calculus is notably rare, underlining the necessity of an exhaustive diagnostic process. The patient successfully underwent a combined surgical intervention, consisting of laparoscopic ureteroureterostomy for RCU correction and ureteroscopic lithotripsy for calculus removal, showcasing a minimally invasive approach to simultaneously address both conditions. This report underscores the significance of advanced cross-sectional imaging in diagnosing RCU and demonstrates the effectiveness of integrated minimally invasive surgical techniques in treating complex urological anomalies. By documenting this case, we contribute to the broader understanding and awareness of RCU among clinicians, potentially guiding more prompt recognition and comprehensive management of this rare condition.
摘要：
腔静脉后输尿管(RCU),也称为输尿管前腔静脉或周围输尿管，是由下腔静脉（IVC）发育不全引起的罕见先天性异常，导致右输尿管在IVC后面行进。RCU导致梗阻性近端输尿管肾积水，无症状，直到第三个十年肾积水发展。诊断依赖于成像方式，如静脉尿路造影（IVU），超声检查,计算机断层扫描尿路造影（CTU），磁共振尿路造影,和核闪烁显像。CTU提供全面的3D评估。我们报告了一例50岁的男性RCU并发输尿管远端结石的新病例。CTU表现出特征性的“S形”近端输尿管畸形及其相对于IVC的后向异常，能够进行准确的术前诊断。RCU与输尿管结石的同时发生尤其罕见，强调详尽的诊断过程的必要性。患者成功接受了联合手术干预，包括用于RCU矫正的腹腔镜输尿管造口术和用于结石清除的输尿管镜碎石术，展示了一种微创方法来同时解决这两种情况。该报告强调了先进的横断面成像在诊断RCU中的重要性，并证明了综合微创外科技术在治疗复杂泌尿系统异常中的有效性。通过记录这个案子，我们有助于临床医生对RCU的更广泛的理解和认识，潜在的指导更迅速地识别和全面管理这种罕见的情况。
