PMC5011217_01
CT scan image showing the "reverse J" deformity.
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Computed tomography (CT) scan after contrast infusion showed right hydroureteronephrosis, with the classical "reverse J" or "fishhook" deformity suggesting the presence of a retrocaval ureter (Figure 1).
The renal pelvis after dissection.
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The classic operative steps were performed for exposure: reflection of the ascending colon medially, identification of the ureter, and dissection of the right renal pelvis (Figure 2).
Renal pelvis, proximal ureter, and retrocaval portion dissected and mobilized.
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Complete mobilization of the retrocaval portion of the ureter was achieved exposing its atretic and scarred portion (Figure 3).
Preparing for pyeloplasty after suspension of the renal pelvis.
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Previous to the reconstructive phase of the operation, we chose to suspend the renal pelvis to the anterior abdominal wall (passing a monofilament wire trough the renal pelvis and the abdominal wall with a straight needle), improving visualization and stabilization and dismissing the need for an "extra hand" (Figure 4).
Starting the anastomosis, first on the posterior side with running suture.
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The anastomosis was performed using 3-0 polyglactin sutures in a continuous, tension-free fashion (Figure 5).
Final look of the anastomosis after inspection.
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The anastomosis was finally inspected confirming water tightness (Figure 6).