Selection of operative procedure for circumcaval ureter (type I). A rational approach.

The surgical treatment of circumcaval ureter (type I) should eliminate the ureteric obstruction which is of variable causation. At operation, the aetiology of the obstruction can be determined by inspection of the extent of ureteric dilatation, perfusion-pressure study and calibration of the lumen. Using this approach, the cause of the obstruction was found to be nonstenotic intrinsic obstruction of the retrocaval segment in two cases of type I circumcaval ureter. In these patients, resection of the obstructing segment and uretero-ureterostomy were carried out. The third patient had pelviureteric junction stenosis which was treated by dismembered pyeloplasty after ureteric relocation.