Isolated retroiliac ureter causing hydronephrosis in a young adult female: a case report

Abstract

Abstract Background A retroiliac ureter is an exceptionally rare congenital anomaly characterized by a posterior course of the ureter relative to the iliac vessels. Its nonspecific clinical and radiological features frequently lead to misdiagnosis, and definitive diagnosis is often made only intraoperatively. The rarity of isolated cases, combined with the diagnostic challenge and delayed recognition, underscores the importance and novelty of reporting this case. Case presentation A 20-year-old Black Ethiopian female presented with a three-year history of right flank pain that had progressively worsened over the preceding year. The pain was associated with urinary frequency, urgency, and dysuria. She had undergone multiple courses of treatment for recurrent urinary tract infections; however, her symptoms persisted despite therapy. Given the prolonged duration of symptoms and recurrent infections, further evaluation was performed. Abdominopelvic ultrasonography and computed tomography revealed evidence of ureteral obstruction. Based on the clinical and imaging findings, surgical intervention was indicated, and the patient underwent ureteral end-to-end anastomosis with placement of a double-J (D-J) stent. Conclusion A retroiliac ureter is a rare congenital urological anomaly that often presents with nonspecific clinical and radiologic findings, which may lead to delayed diagnosis. Failure to recognize this condition may result in progressive obstruction and renal impairment. This case highlights the importance of maintaining a high index of clinical suspicion in patients with unexplained ureteral obstruction, as timely surgical intervention can effectively relieve obstruction, preserve renal function, and lead to favorable clinical outcomes.