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. 2021 Jun:83:106031.
doi: 10.1016/j.ijscr.2021.106031. Epub 2021 May 26.

Lower ureteral compression through external vascular elongation in a cyclist: A case report

Christian Ramesmayer  1 , Michael Mitterberger  2 , Lukas Oberhammer  2 , Thomas Kunit  2 , Lukas Lusuardi  2
Affiliations

Lower ureteral compression through external vascular elongation in a cyclist: A case report

Christian Ramesmayer et al. Int J Surg Case Rep. 2021 Jun.

Abstract

Introduction and importance: There is sparse literature about lower ureteric obstruction due to aberrant blood vessels. We report a case of a patient who was referred to our hospital due to left sided flank pain caused by external compression of the distal ureter.

Case presentation: A 47-year-old male patient presented with left sided flank pain. A computed tomography scan revealed external compression of the lower ureter. Hypertrophy of the psoas muscle due to extensive cycling for 20 years lead to concomitant kinking and elongation of the iliacal vessels which caused the distal ureteric obstruction. Robotic-assisted laparoscopic ureterocystoneostomy with psoas hitch technique was performed.

Clinical discussion: Lower ureteric obstruction, mostly seen in children, is mostly caused by vascular anomalies such as a persistent umbilical artery. After literature review, we presume it to be the first reported case of distal ureteric obstruction caused by external vascular elongation.

Conclusion: The external elongation of pelvic vessels due to excessive cycling and the concomitant extrinsic compression of the distal ureter should be considered as rare but possible cause of lower uretic obstructions.

Keywords: Case report; Crossing vessel; Lower ureteric obstruction; Ureterocystoneostomy; Vascular elongation.

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Conflict of interest statement

The authors report no declaration of interest.

Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography scan (arterial phase) showing slightly enlarged common iliac artery with kinking and concomitant secondary hydronephrosis.
Fig. 2
Fig. 2
Retrograde Ureteropyelography showing ureteral kinking and distal obstruction.
Fig. 3
Fig. 3
Intraoperative picture showing compression of the lower ureter (LU) caused by arterial kinking of the iliac artery (IA). The LU is connected with the artery by fibrous tissue (FT).
See this image and copyright information in PMC

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