an unusual cause of ureteral obstruction—role of magnetic resonance imaging
TRANSCRIPT
Images in Clinical Urology
An Unusual Cause of Ureteral Obstruction—Role of Magnetic Resonance ImagingPunit Tiwari, Astha Tiwari, Suresh Kumar, and M. K. Bera
We report an unusual cause of right ureteral obstruction by a normal running right spermatic vein in a 55-year-old man.Laparoscopic resection of the right spermatic vein was done. To the best of our knowledge, only 1 such case has been
previously reported. UROLOGY 78: 779–781, 2011. © 2011 Elsevier Inc.ctv
A55-year-old man presented with recurrent rightflank pain of 2 years’ duration. The pain wasdull, aching, and occasionally colicky. All find-
ings from the routine investigation were within normallimits. Ultrasonography showed right hydronephrosiswith a dilated proximal ureter. Intravenous urographywas suggestive of a retrocaval ureter. Magnetic resonanceurography was performed (Fig. 1) and showed dilation ofthe proximal ureter with a sharp angulation and cutoffjust proximal to the normal running right spermatic vein,which was draining into the vena cava. Retrograde ure-terography showed the level of obstruction with no in-trinsic ureteral obstruction (Fig. 2). On laparoscopic ex-ploration, the right ureter was markedly dilated and wasanterior to the vena cava. The obstruction was found atthe point at which the ureter passed behind the rightspermatic vein, which was transected. We observed acollapse of the dilated ureter with good peristalsis. Hispostoperative course was uneventful. Intravenous urogra-
From the Department of Urology, IPGMER, SSKM Hospital, Kolkata, IndiaReprint requests: Punit Tiwari, M.Ch., Department of Urology, IPGMER, SSKM
Hospital, Kolkata-95, India. E-mail: [email protected]: December 20, 2010, accepted (with revisions): January 8, 2011
© 2011 Elsevier Inc.All Rights Reserved
phy at 3 months postoperatively showed residual hy-droureteronephrosis on the right side, with the patientcompletely relieved of symptoms. Obstruction of ureterby an aberrant vessel is not uncommon, but obstructionby the spermatic vein is rare.1-3 It was diagnosed withertainty only with magnetic resonance imaging, In con-rast to the case in women, in whom an enlarged ovarianein can cause obstruction of the ureter,4,5 no dilation or
congestion was seen in our case. Most investigators haverecommended resection of the ovarian vein on the in-volved side4 to relieve the symptoms.
References1. Mellin HE, Madsen PO. Obstruction of ureter by abnormal right
spermatic vein. Urology. 1975;6:517-519.2. Kretkowski R, Shah N. Testicular vein syndrome—unusual cause of
hydronephrosis. Urology. 1977;3:253-254.3. Lassnig H, Frick J. Left spermatic vein syndrome. Eur Urol. 1978;4:
141-143.4. Almeida A, Cavalcanti F, Barbosa S, et al. Laparoscopic approach in
the ovarian vein syndrome. Int Braz J Urol. 2003;29:45-47.5. Otnes B, Enge I, Mathisen W. The ovarian vein syndrome, a cause
of ureteral obstruction; report of a case. Scand J Urol Nephrol.
1972;6:206-209.0090-4295/11/$36.00 779doi:10.1016/j.urology.2011.01.015
Figure 1. (A) Magnetic resonance urogram showing dilated proximal ureter with sudden narrowing of ureter just lateral to
vena cava with gonadal vein crossing it. (B) Narrowing of ureter at crossing of right spermatic vein.780 UROLOGY 78 (4), 2011
Figure 2. Retrograde pyelogram showing sharp narrowing of ureter with angulation and proximal dilation.
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