Bririsli Jorrrtrol of Urology (1976). 48, 18
0
Short Case Report
Midline Ensheathed Ureters A 2-year-old boy was investigated for “failure to
thrive” and found to have a urinary infection and bilateral hydronephrosis. There was no ureteric reflux and cystoscopic appearances were normal. A ureteric stricture, 2 cnis from a normal left pelvi-ureteric junction, was excised. Exploration on the right side revealed a retrocaval ureter obstructed by thc cava just distal to the pelviureteric junction. The vena cava and aorta bifurcated at this level. At a lower level, in the midline, the right and left ureters were ensheathed by a fibrous membrane (Figs. I and 2). This sheath was divided, freeing both ureters. The right ureter was divided at the pelviureteric junction, delivered anterior to the vena cava and anastomosed to the renal pelvis. The patient made an uneventful recovery. He remained well and symptom free 2 years later. The function of his left kidney is poor but the right renal function is good.
Comment
Fig. I . A photograph showing both uretcrs (taped superiorly) ensheathed in midline.
Retrocaval ureter is due to persistence of the right postcardinal vein (McClure and Butler, 1925) or the right subcardinal vein (Gruenwald, 1938). In this case the high junction of the iliac veins is probably due to persistence of the postcardinal vein on the right and the supracardinal vein on the left. The sheath may represent vestigial tissue from the embryonic iliac anastomosis. R. J . SALEM and R. J. LUCK Department of SurKery, Heatherwood Hospital, Ascot, Berkshire
References GRUENWALD, P. (1938). Die Genese der Fehlbildungen der Vena Cava caudalis (inferior). Beitraege zur Pathologischen Anatornie, 101, 439-456. MCCLURE, C. F. W. and BUTLER, E. G. (1925). The development of the vena cava inferior in man. American Journal of Anatoniy, 35, 33 1-384.
& ,,,^.,.,
Fig. 2
18
0
Short Case Report
Midline Ensheathed Ureters A 2-year-old boy was investigated for “failure to
thrive” and found to have a urinary infection and bilateral hydronephrosis. There was no ureteric reflux and cystoscopic appearances were normal. A ureteric stricture, 2 cnis from a normal left pelvi-ureteric junction, was excised. Exploration on the right side revealed a retrocaval ureter obstructed by thc cava just distal to the pelviureteric junction. The vena cava and aorta bifurcated at this level. At a lower level, in the midline, the right and left ureters were ensheathed by a fibrous membrane (Figs. I and 2). This sheath was divided, freeing both ureters. The right ureter was divided at the pelviureteric junction, delivered anterior to the vena cava and anastomosed to the renal pelvis. The patient made an uneventful recovery. He remained well and symptom free 2 years later. The function of his left kidney is poor but the right renal function is good.
Comment
Fig. I . A photograph showing both uretcrs (taped superiorly) ensheathed in midline.
Retrocaval ureter is due to persistence of the right postcardinal vein (McClure and Butler, 1925) or the right subcardinal vein (Gruenwald, 1938). In this case the high junction of the iliac veins is probably due to persistence of the postcardinal vein on the right and the supracardinal vein on the left. The sheath may represent vestigial tissue from the embryonic iliac anastomosis. R. J . SALEM and R. J. LUCK Department of SurKery, Heatherwood Hospital, Ascot, Berkshire
References GRUENWALD, P. (1938). Die Genese der Fehlbildungen der Vena Cava caudalis (inferior). Beitraege zur Pathologischen Anatornie, 101, 439-456. MCCLURE, C. F. W. and BUTLER, E. G. (1925). The development of the vena cava inferior in man. American Journal of Anatoniy, 35, 33 1-384.
& ,,,^.,.,
Fig. 2
18
