Question

The operation of choice for a retrocaval ureter is

• A. Cutting and suturing the inferior vena cava
• B. Cutting and suturing the ureter
• C. Anderson-Hynes pyeloplasty
• D. Ureterocystoplasty

Hint:

The fix targets the ureter's abnormal path, not the normal inferior vena cava.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
A retrocaval ureter, also called a circumcaval ureter, is a rare congenital anomaly where the right ureter winds behind and around the inferior vena cava (IVC), instead of running straight down beside it. This can obstruct urine flow and cause hydronephrosis. The question asks which operation treats this condition.

Step 2: Key Concept:
The IVC is a large, important vein that carries almost all the blood returning from the lower body to the heart, so surgeons avoid cutting it whenever possible. The abnormality here lies in the course of the ureter, not in the IVC itself, so the correct fix should target the ureter.

Step 3: Detailed Explanation:
The standard operation divides the obstructed ureter at the point where it passes behind the IVC, brings the two cut ends back in front of the IVC in their normal position, and rejoins them with sutures (ureteroureterostomy). This relieves the obstruction while keeping the IVC completely intact.
Cutting and suturing the IVC is not done, since the IVC is structurally normal and injuring it risks serious bleeding and interrupts venous return from the legs.
Anderson-Hynes pyeloplasty is the operation for pelviureteric junction obstruction, a different condition where the narrowing is where the renal pelvis joins the ureter, not where the ureter loops around the IVC.
Ureterocystoplasty is a bladder augmentation procedure using ureteric tissue, and it has no role in correcting a retrocaval ureter.

Step 4: Final Answer:
The operation of choice for a retrocaval ureter is cutting and suturing (dividing and reanastomosing) the ureter, after repositioning it in front of the IVC.