[Surgical correction of hydronephrosis in the retrocaval ureter]

The authors operated on 2 patients aged 12 and 13 years who had hydronephrosis and retrocaval ureter. Ureteropelvic segment resection with anastomotic plastic repair were antecavally made by the Anderson-Hynes-Kucera procedure in both patients. Good results were obtained. The follow-ups lasted 1 and 3 years. Histological studies of the ureteropelvic segments resected revealed structural changes in the wall, they were mainly of inborn genesis. The signs of malformations were ureteral wall sclerosis mainly located in the tunica submucosa; impaired myoarchitectonics as hypoplasia and disorganized muscle fascicles. The amount of agrophilic and elastic fibers was decreased. The findings led to the conclusion that the cause of hydronephrosis in the retrocaval ureter is ureteral wall structural abnormalities mainly of inborn genesis rather than the abnormal position of the ureter. These data show it necessary to resect the destructively changed segment to form a pyeloureteral anastomosis by using morphofunctionally normal tissues. The good outcomes of surgical correction of hydronephrosis with antecaval transposition of the anastomosis provide evidence for its pathogenetic rationale.