Bilateral ureteral compression by iliac arteries

Case contributed by Mostafa El-Feky
Diagnosis almost certain


Bilateral loin pain, dysuria and frequency.

Patient Data

Age: 45 years
Gender: Female

Bilateral symmetrical ureteric narrowing at sites of iliac arteries crossing with proximal mild hydroureteronephrosis, more on right side. Normal caliber of both ureters distally.

Small paraumbilical hernia transmitting fatty content.

Case Discussion

Impressions on the ureters are commonly seen at the level of iliac vessels crossing and are considered as one of the three known sites of anatomic narrowing besides pelviureteric and vesicoureteric junctions. These are often deep and seem to cause minor degrees of obstruction, however, appear not to be clinically significant 1,4.

Strictures also can occur at site of iliac vessels crossing, as it is considered a vascular watershed transition area, at which blood supply changes from abdominal aorta to iliac and hypogastric arteries 2.

Extrinsic vascular compression on lower ureters by blood vessels is rare. This can be due to persistent umbilical artery in children, aortoiliac aneurysms and vascular elongation and kinking of the pelvic vessels 3.

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