case_images: PMC11800099_01
case_images: a-f: Preoperative computed tomography images. Fig. 1a: Coronal view - arterial phase of CT abdomen with intravenous and oral contrast showing left lower pole accessory renal vessels (yellow arrow) crossing the left ureter anteriorly. Fig. 1b: Axial view - delayed phase of CT abdomen with oral and intravenous contrast showing right renal pelvis (yellow arrow) coursing behind the IVC (blue arrow) consistent with type 2 retrocaval ureter. Fig. 1c: Axial view - arterial phase of CT abdomen with oral and intravenous contrast showing right renal pelvis (yellow arrow) coursing behind the IVC (blue arrow) consistent with type 2 retrocaval ureter. Fig. 1d: Coronal view - delayed phase of CT abdomen with oral and intravenous contrast showing bilateral hydronephrosis Grade 3 (yellow arrows). Fig. 1e: Coronal view - venous phase of CT abdomen with oral and intravenous contrast, showing the IVC (yellow arrow) anterior to the renal pelvis (orange arrow). Fig. 1f: Axial view - arterial phase of CT abdomen with oral and intravenous contrast illustrating left retroaortic renal vein (yellow arrow) coursing behind the aorta (blue arrow)..
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case_images: fig1
case_images: A CT Urogram performed demonstrated a right retrocaval ureter classified as a Type 2 with proximal hydronephroureterosis (Fig. 1a-f), accessory left renal artery and vein supplying and draining the lower pole, respectively, with these vessels crossing the proximal left ureter, likely causing obstruction of the left kidney.
case_images: Intraoperative Images Before Pyeloplasty. Illustrating the right proximal ureter (white arrow) emerging from behind the inferior vena cava (Black arrow), characteristic of a type 2 retrocaval ureter..
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case_images: The inferior vena cava (IVC) and the ureter were identified (Fig. 2).
case_images: Intraoperative Images after transection and transposition of right ureter and Pyeloplasty. Depicting the right ureter (white arrow) anterior to the inferior vena cava (Black arrow) and the site of pyeloplasty (blue arrow)..
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case_images: The ureter was dissected and cut at the UPJ before being placed anterior to the IVC, followed by a simple pyeloplasty (Heineke), which was performed with a double-J (DJ) stent in place (Fig. 3).
case_images: Intraoperative Images Before Left Pyeloplasty. Depicting the left ureter (white arrow) and a crossing aberrant vessel (black arrow)..
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case_images: The crossing vessels were then identified (Fig. 4), and the stenotic segment was resected.