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Review
. 2025 Aug 30;14(8):2456-2466.
doi: 10.21037/tau-24-580. Epub 2025 Aug 26.

Retrocaval ureter: a narrative review

Sonia Pérez-Bertólez  1 , Paula Salcedo  1 , Leopoldo Tapia  1 , Anna Domenech  1 , Oriol Martín-Solé  1 , Luis García-Aparicio  1
Affiliations
Review

Retrocaval ureter: a narrative review

Sonia Pérez-Bertólez et al. Transl Androl Urol. .

Abstract

Background and objective: Retrocaval ureter is a rare congenital anomaly resulting from the abnormal development of the inferior vena cava (IVC), where the ureter passes posteriorly and loops around the IVC. This review aims to provide a comprehensive overview of the etiology, classification, clinical presentation, diagnostic approaches, and management strategies for retrocaval ureter.

Methods: We performed a narrative, non-systematic literature review using PubMed, Google Scholar, Embase, and Web of Science for articles related to retrocaval ureter to perform a narrative review of the current literature on retrocaval ureter, including clinical case series, reviews, and surgical outcome studies. Emphasis was placed on diagnostic imaging, surgical techniques, and outcomes.

Key content and findings: Retrocaval ureter has an estimated incidence of 1 in 1,000 births and is more frequently diagnosed in males. It is classified into two anatomical types, with Type 1 being more common and often associated with significant hydronephrosis. Advances in imaging, including computed tomography (CT) urography and magnetic resonance (MR) urography, have improved diagnostic accuracy. The management of retrocaval ureter varies depending on the severity of symptoms, but surgical correction, primarily through minimally invasive techniques like laparoscopic or robotic ureteroureterostomy, is the treatment of choice in symptomatic patients. Minimally invasive surgery offers reduced recovery time and excellent outcomes.

Conclusions: Retrocaval ureter is a rare but significant condition that can lead to ureteral obstruction and hydronephrosis. Early diagnosis through modern imaging and prompt surgical intervention in symptomatic cases can prevent long-term renal damage. Minimally invasive techniques have emerged as the gold standard for surgical management, offering favorable outcomes with minimal complications.

Keywords: Retrocaval ureter; circumcaval ureter; congenital anomalies; ureteral obstruction.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-580/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Retrocaval ureter.
Figure 2
Figure 2
Embryology. (A) Normal development of the inferior vena cava. (B) Abnormal development of the inferior vena cava, leading to a retrocaval right ureter.
Figure 3
Figure 3
Radiological classification of retrocaval ureter: (A) type 1, (B) type 2.
Figure 4
Figure 4
Intravenous urography. (A) Right retrocaval ureter type 1 with proximal ureterohydronephrosis. (B) Right retrocaval ureter type 2 with mild proximal ureterohydronephrosis.
Figure 5
Figure 5
Ultrasound of patients with right retrocaval ureter. (A) Hydronephrosis; (B) dilatation of the proximal right ureter.
Figure 6
Figure 6
Diuretic renogram with 99mTc-MAG3 showing a right obstructive pattern with preserved renal function.
Figure 7
Figure 7
Uretero-ureterostomy with ureteral transposition.
Figure 8
Figure 8
Right retrocaval ureter. Transperitoneal laparoscopic approach. IVC, inferior vena cava.
Video 1
Video 1
Right retrocaval ureter. Transperitoneal laparoscopic approach. Following careful dissection of the ureter from the inferior vena cava, a shoeshiner maneuver is performed to verify complete circumferential mobilization and ensure that no residual adhesions remain between the ureter and the vascular wall.
Figure 9
Figure 9
Inferior vena cava support.
See this image and copyright information in PMC

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