A Case of Retrograde Treatment of a Ureteral Stone in a Retrocaval Ureter.

Background

Retrocaval ureter is a rare entity with a reported incidence of ∼1 in 1100 and a 2.8-fold male predominance. The course of the ureter could be classified, using an intravenous urography, as type 1 having S-shaped, fish-hook, or J-shaped retrocaval course or type 2 having sickle-shaped course. No case report describing retrograde endoscopic management of ureteral calculi in the presence of retrocaval ureter could be found in existing literature. We are presenting a case of type I retrocaval ureter with ureteral calculi and nonobstructive drainage, which was effectively managed by flexible ureteroscopy. Case Presentation: A 62-year-old Caucasian man presented with complaints of a renal colic. The patient was positive for a history of noninsulin-dependent diabetes and hypertension. A direct abdomen CT scan showed an 8 mm ureteral stone with suspected retrocaval course of right proximal ureter with no hydronephrosis. After informed consent, ureteroscopy was performed on the patient's right proximal ureter. No complications occurred intraoperatively and postoperatively. On follow-up of up to 3 months, patient was asymptomatic and direct abdomen CT scan showed normal kidney without hydronephrosis.

Conclusion

In the presence of retrocaval ureter and associated ureteral calculi with a condition of nonobstructive drainage, retrograde ureteroscopy is a safe and optimal procedure.