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

A retrocaval ureter is a birth defect where the right ureter takes a wrong turn behind the inferior vena cava (IVC), which can block urine flow. The question asks which surgery fixes this.

1. Cutting and suturing the IVC: The IVC itself is normal here, it is only the ureter that has an abnormal path. Cutting a major vein carries needless bleeding risk, so this is not done.
2. Cutting and suturing the ureter: The ureter is divided at the point where it loops behind the IVC, brought forward to lie in its normal position in front of the IVC, and stitched back together. This clears the obstruction while leaving the IVC untouched, making it the actual operation of choice.
3. Anderson-Hynes pyeloplasty: This surgery treats narrowing at the pelviureteric junction, a completely different site and cause of obstruction, so it does not apply here.
4. Ureterocystoplasty: This is a bladder enlargement procedure using ureteric tissue, unrelated to correcting an abnormal ureteric course.

The correct operation is division and reanastomosis of the ureter in front of the IVC, so the answer is cutting and suturing the ureter.

Let's summarize:

• Retrocaval ureter is a ureteric problem, so the surgery is done on the ureter, not the vein.
• Pyeloplasty and ureterocystoplasty treat different conditions and do not fix a retrocaval course.

So the operation of choice is cutting and suturing the ureter.