Retrocaval ureter combined with retroperitoneal fibrosis - A case report

Differential diagnosis of right ureteral obstruction includes such rare con ditions as retrocaval ureter and retroperitoneal fibrosis. We here report o n a patient with retroperitoneal fibrosis associated with a retrocaval uret er. A 47 year old man presented with diffuse pain in both lower quadrants and f lanks, weakness and weight loss of 7 kg over 3 weeks. Radiologic investigat ion revealed a retrocaval ureter in combination with retroperitoneal fibros is leading to a dicompensated obstuction of right upper urinary tract. Surg ical exploration was performed through a right flank incision for both, dia gnostic, to exclude malignancy, and therapeutic reasons. The ureter was fre ed from the fibrotic tissue and the retrocaval stenotic segment was resecte d. In addition, a standard Anderson-Hynes pyeloplasty was performed and the ureter was wrapped into an omental flap. Following surgery, a low dose cor ticosteroids and azathioprine therapy was initiated. In conclusion, differential diagnosis of ureteral obstruction includes extr insic ureteral compression by retroperitoneal masses and retrocaval ureter. Obstruction of a retrocaval ureter in its unique anatomical position by re troperitoneal fibrosis is extremely rare and requires surgical treatment.