Images in Surgery - Retrocaval ureter

A 44-year-old man presented with dull intermittent right lumbar pain. Routine examination of urine and plain abdominal x-ray were normal. Ultrasonography and intravenous urogram (IVU) showed hydronephrosis and upper hydroureter with a "J" deformity on the right side. Retrograde pyelography (RGP) of the right side showed a tortuous, dilated ureter in the shape of an italic S, beginning just above the pelvic brim and ending below the renal pelvis. Ureteric catheter could not be passed up to the renal pelvis. Operation done by a right lumbar approach showed a retrocaval ureter. The dilated caudal ureteric segment was excised. The ureter was then reanastomosed to the proximal dilated segment anterior to the inferior vena cava.