The right ureter passes behind the inferior vena cava at the level of the third and fourth lumbar vertebrae, then curves forward and laterally to enter the bladder via the normal pathway. The cause of this condition is abnormal embryonic development of the inferior vena cava, leading to an abnormal position of the upper segment of the right ureter. The upper third of the right ureter lies behind the vena cava and wraps around it before returning to its anterior position. Compression or fibrosis of the upper ureter leads to hydronephrosis of the right kidney, as well as infection and stones. The disease progresses slowly, with symptoms typically appearing around the age of 40. Surgical treatment is the primary approach, and the prognosis is favorable as long as kidney function has not been severely compromised. This condition is more common in males, with a male-to-female ratio of 3:1.

bubble_chart Clinical Manifestations

1. Stuffy pain in the right lumbar region, and renal colicky pain may occur in cases complicated by stones.
2. Fever and hematuria may be present if combined with urinary tract infection.
3. Physical examination reveals tenderness and percussion pain in the right renal area. If hydronephrosis is severe, a cystic mass in the right upper abdomen may be palpable.

bubble_chart Auxiliary Examination

1. If there are no clinical symptoms during adolescence, no examination is necessary;
2. if IVP reveals suspicion of this disease, cystoscopy plus retrograde pyelography should be performed, which can basically confirm the diagnosis and provide information on the length of the compressed ureteral segment, offering evidence for surgical planning;
3. if the diagnosis remains unclear and other ureteral or renal pathologies cannot be ruled out, CT or MRI may be performed.

bubble_chart Diagnosis

1. When complicated by hydronephrosis, stones, and infection, symptoms such as lumbago, hematuria, fever, and pyuria may occur.
2. Urography can reveal hydronephrosis of the right kidney and an "S"-shaped or sickle-shaped curvature of the right ureter. If necessary, simultaneous catheterization via the great saphenous vein into the inferior vena cava for venography can demonstrate the relationship between the right ureter and the inferior vena cava, further aiding in diagnosis.
3. IVP shows hydronephrosis of the right kidney, dilation of the upper segment of the right ureter, and medial displacement.

bubble_chart Treatment Measures

1. Although there is ureteral obstruction, if renal function is still good, ureteral repositioning can be performed. The ureter should be severed above the junction of the renal pelvis and ureter, and if necessary, the abnormal segment of the ureter should be excised. The ureter is then moved anterior to the inferior vena cava for end-to-end anastomosis (Harrill's method).
2. If the affected kidney's function is severely impaired and the contralateral kidney functions well, a nephrectomy of the affected side may be performed.
3. For simple hydronephrosis without infection or complications, only oral antibiotics are needed to prevent infection, typically for 3 to 5 days.
4. If preoperative hydronephrosis is severe and accompanied by infection, sensitive antibiotics and those with low nephrotoxicity can be used before and after surgery to ensure reduced postoperative infection. The course generally lasts 7 to 10 days.
5. Pay attention to using nephroprotective drugs to preserve renal function.