Retrocaval Ureter: The Importance of Intravenous Urography
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Retrocaval Ureter: The Importance of Intravenous Urography
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:
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Radhiana Hassan, Azian Abd Aziz, Siti Kamariah Che Mohamed
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Retrocaval Ureter: The Importance of Intravenous Urography
Year: 2011
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Retrocaval ureter is a rare congenital anomaly that arises from abnormal development of the inferior vena cava, resulting in the ureter being compressed by the vessel, which can lead to hydronephrosis. With an incidence of approximately 1 in 1000 individuals and a tendency to occur more frequently in men, the clinical manifestation typically presents in patients between 30 to 40 years of age. Distinguishing retrocaval ureter from more common causes of urinary obstruction, such as urolithiasis, is crucial for effective surgical management. While multislice computed tomography (MSCT) has largely supplanted intravenous urography (IVU) in diagnosing hydronephrosis, there are scenarios where IVU may reveal critical details overlooked by MSCT, particularly when there is inadequate opacification of the ureter.
Importance of IVU in Diagnosing Retrocaval Ureter
In a reported case of a 62-year-old man with suspected urinary obstruction, MSCT indicated persistent right hydronephrosis without demonstrating any ureteric calculus. The right ureter was only partially visualized due to poor contrast filling, leading to an initial focus on ureteric stricture as a potential cause. However, subsequent IVU clearly illustrated the characteristic features associated with retrocaval ureter, including the medial deviation of the ureter at the L3 vertebral level. This case underscores the importance of using IVU, which can provide high-resolution images and better detail in visualizing congenital anomalies compared to MSCT, especially when anomalies are subtle and the presentation is complex.
Conclusion
Despite the advancements in imaging technology, the diagnosis and assessment of conditions like retrocaval ureter can still benefit from traditional methods such as IVU. The ability of IVU to provide clear images of ureteral abnormalities plays a significant role in ensuring accurate diagnosis, ultimately guiding appropriate surgical intervention. Given the challenges MSCT may present in visualizing congenital anomalies due to its reliance on contrast enhancement, maintaining proficiency in IVU remains essential for evaluating complex genitourinary conditions. As demonstrated, recognizing the limitations of modern imaging modalities is critical for optimizing patient outcomes through proper diagnosis and management strategies.
FAQ section (important questions/answers):
What is a retrocaval ureter and how does it occur?
A retrocaval ureter is a rare congenital anomaly where the ureter passes behind an abnormal inferior vena cava (IVC), causing obstruction and hydronephrosis. It usually presents in adults aged 30-40 as the condition develops gradually.
How is retrocaval ureter diagnosed using imaging studies?
Imaging studies like intravenous urography (IVU) provide high-resolution images that highlight the characteristic fish hook appearance of the ureter. Multislice computed tomography (MSCT) can miss this diagnosis if the ureter is inadequately opacified.
What are the treatment options for retrocaval ureter?
Treatment depends on the severity and renal impairment. Options include conservative management for mild cases, or ureteroureteral reanastomosis with resection of the retrocaval segment for more severe presentations.
Why might IVU be preferred over MSCT in some cases?
IVU is beneficial due to its ability to provide good image resolution and can be adapted to visualize the entire ureter. It can be particularly useful in assessing rare congenital anomalies like retrocaval ureter.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Retrocaval Ureter: The Importance of Intravenous Urography”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Arrow:
The term 'Arrow' in the context of medical imaging often refers to annotations made on images to highlight specific findings, like the 'fish hook' appearance of the ureter in retrocaval ureter cases. These annotations guide clinicians in identifying anomalies and aid in accurate diagnosis.
2) Filling (Filled):
'Filling' refers to the process of contrast material being introduced during imaging studies like IVU and CT scans. Adequate filling is crucial for visualizing the urinary tract anatomy. Poor filling can obscure lesions and anatomical abnormalities, thus complicating the diagnostic process, as observed in the case report.
3) Sahani:
Dr. Sahani is cited in reference to studies relating to imaging techniques and urolithiasis management. His contributions underscore the evolving concepts in diagnostic radiology. Insights from Sahani's work emphasize the importance of accurate imaging in differentiating between conditions such as ureteral stones and congenital anomalies.
4) Vena:
'Vena' is part of the term 'vena cava', referring to a large vein. In the context of a retrocaval ureter, the inferior vena cava's position is critical; it can compress the ureter, leading to hydronephrosis. Understanding vascular anatomy is vital for surgical planning and intervention.
5) Fish:
The term 'Fish' relates to the 'fish hook' appearance noted in retrocaval ureter cases on imaging studies. This characteristic shape is essential for diagnosis and reflects the abnormal pathway that the ureter takes due to its positional relationship with the inferior vena cava.
6) Pur:
'Poor' is used to describe inadequate opacification of the ureter observed in imaging studies. This lack of contrast filling can hinder the visibility of anatomical structures, leading to potential misdiagnosis, as highlighted in the case report where a retrocaval ureter was initially overlooked.
7) Disease:
In this context, 'Disease' refers to urological conditions, including congenital anomalies like retrocaval ureter that can lead to hydronephrosis. Accurate diagnosis is essential to determine the appropriate management approach, since these diseases often present with non-specific symptoms similar to more common conditions.
8) Sharman (Sarma, Sharma, Sarman):
Dr. Sharma's work is referenced in relation to imaging and diagnostic methods in urology. His contributions emphasize the importance of recognizing congenital urological anomalies and the need for thorough imaging techniques to ensure accurate diagnosis and effective treatment.
9) Nature:
'Nature' in this context could refer to the intrinsic characteristics of conditions like retrocaval ureter. Understanding the nature of these congenital anomalies is critical in clinical practice, as it influences diagnostic strategies and management options for affected patients.
10) Indian:
The term 'Indian' references a geographical and cultural context for various studies and clinical research mentioned in the text. It reflects the global nature of urological practices and challenges in diagnosing conditions like retrocaval ureter, which may vary in presentation across different populations.
11) Study (Studying):
'Study' refers to the systematic investigation included in the references that contribute to the medical understanding of conditions like retrocaval ureters and urolithiasis. Such studies enhance the knowledge base necessary for effective diagnosis and management in urology.
12) Sign:
'Sign' denotes clinical or radiological findings that indicate the presence of a medical condition. In the context of retrocaval ureters, specific signs observed on imaging can suggest congenital anomalies, guiding physicians toward a correct diagnosis and treatment plan.
13) Pose:
'Pose' is used to describe the challenge or difficulty encountered in diagnosing retrocaval ureter. The non-specific symptoms and rarity of the condition can pose diagnostic dilemmas for physicians, emphasizing the need for a comprehensive understanding of various urological disorders.
14) Pain:
In the clinical context, 'Pain' may refer to the symptoms associated with urinary tract obstruction due to a condition like retrocaval ureter. It highlights the importance of effectively assessing and managing pain linked to underlying urological issues in patients.
15) Gold (Golden):
'Gold' is associated with the term 'gold standard,' emphasizing the importance of accurate diagnostic methods in urology. Advanced imaging techniques like MSCT and IVU are crucial in identifying conditions such as retrocaval ureters, ensuring optimal patient care.
16) Male:
'Male' signifies the demographic trend observed in conditions like retrocaval ureter, which often show a predominance among males. Understanding such distinctions aids clinicians in risk assessment and management strategies for urological disorders.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Retrocaval Ureter: The Importance of Intravenous Urography’. Further sources in the context of Science might help you critically compare this page with similair documents:
Mri, Surgical intervention, Clinical examination, Surgical treatment, Urolithiasis, Urinary tract, MRI diagnosis, Clinical presentation, Laboratory investigation, Male predominance, Renal function, Computed tomography scan, Inferior vena cava, Hydronephrosis, Renal pelvis, Congenital disorder, Renal impairment, Benign prostatic hypertrophy, Flank Pain, Ureterolithiasis, Imaging studies, Urinary tract obstruction, Radiological features, Urology, Cystoscopy, Ureteral Stricture, Clinical needs, Multislice computed tomography, Intravenous urography, Intravenous urogram, Medical professional.
Concepts being referred in other categories, contexts and sources.