Congenital midureteral stenosis in children: a 13-year retrospective study based on data from a large pediatric medical center

A case report of congenital ureteral stricture: Obstructed, hydronephrotic solitary kidney with cystic dysplastic changes

INTRODUCTION AND IMPORTANCE

Congenital ureteral stricture is a rare cause of antenatal hydronephrosis. Early diagnosis and treatment is important to prevent progressive loss of renal function.

CASE PRESENTATION

This is a case report a 5 month old infant with obstructed hydronephrotic solitary kidney detected during antenatal ultrasound. She was operated, and Intraoperative finding was proximal ureteric stricture and it was managed by pyeloplasty.

CLINICAL DISCUSSION

Congenital anomalies of the urinary tract and kidney are the leading cause of end-stage renal disease in children. Congenital ureteral stricture is commonly misdiagnosed as ureteropelvic junction (UPJ) obstruction preoperatively. The most common location for congenital ureteral stricture is the mid ureter, but there are a few case reports of congenital ureteral stricture occurring in the proximal ureter.

CONCLUSION

Ureteral stricture is usually associated with other urological anomalies such as, multi-cystic dysplastic kidney, mega ureter, and renal agenesis So diagnosis should not be delayed in such cases to prevent progressive loss of renal function, and end stage renal disease.

Trisomy 13 with retroiliac ureter diagnosed by assessment for recurrent febrile urinary tract infections

Introduction

Patients with trisomy 13 have multiple malformations, including urological anomalies, and severe cognitive and psychomotor disabilities. We conducted a ureteroureterostomy for a mid-ureteral stricture due to a retroiliac ureter in a patient with trisomy 13.

Case presentation

A 6-month-old girl with trisomy 13 developed a urinary tract infection. Computed tomography for assessing recurrent urinary tract infection revealed a left mid-ureteral stricture due to the retroiliac ureter. At the age of 2, a ureteroureterostomy was performed. Two years after surgery, the urinary tract infection did not recur.

Conclusion

Ureteroureterostomy is a safe procedure for children with trisomy 13 and multiple comorbidities. Surgical treatment should be considered for patients with trisomy 13 when agreed upon by the family and comorbidities are well-controlled.

A case of mid-ureteral stricture with ipsilateral atrophic kidney in a young adult

Introduction

Most congenital ureteral strictures occur at the ureteropelvic or ureterovesical junction in children. Mid-ureteral stricture is very rare and can cause congenital hydronephrosis. Only a few studies have reported on coexisting mid-ureteral stricture with ipsilateral atrophic kidney in young adults.

Case presentation

A 16-year-old girl presented with repeated urinary tract infection. Computed tomography revealed a right atrophic kidney and hydroureter. Retrograde pyelography showed a mid-ureteral stricture. Laparoscopic nephroureterectomy was performed, and histological examination revealed mid-ureteral stricture with hyperplasia of the fibrous connective tissue and an atrophic kidney.

Conclusion

Mid-ureteral stricture in a young adult is extremely rare. Appropriate imaging studies including retrograde pyelography are necessary for accurate diagnosis of mid-ureteral stricture.

Long-term, single-center study comparing open and laparoscopic procedures for congenital midureteral obstruction in children

PURPOSE

To compare the safety and outcomes of open and laparoscopic procedures in the management of congenital midureteral obstruction in children (CMO).

METHODS

Between February 2008 and February 2022, a total of 18 patients underwent open ureteroureterostomy (OU group), and 26 underwent laparoscopic ureteroureterostomy (LU group). The operative time, postoperative hospital stay, hospital costs, postoperative complications, and success rates of the two groups were compared.

RESULTS

The median age of the patients was 59 months, with 29 patients presenting with asymptomatic hydronephrosis, 12 with intermittent abdominal pain, and 3 with flank mass. The median follow-up time was 42 months, and all patients were successfully treated surgically. The operative time and postoperative hospital stay in the LU group were shorter than those in the OU group (106.3 ± 21.4 vs. 85.8 ± 16.5 min, 11.6 ± 1.9 vs. 8.3 ± 1.7 days, respectively; p < 0.05). The OU group had two postoperative complications, both of which were classified as Clavien-Dindo grade II based on the Clavien-Dindo classification. One case of postoperative complication occurred in the LU group, which was classified as Clavien-Dindo Grade II. There was no significant statistical difference in complications between the two groups (P > 0.05).

CONCLUSIONS

Our data showed that laparoscopic ureteroureterostomy is a safe and effective treatment for congenital midureteral obstruction in children, and provides several advantages, including fewer postoperative complications, shorter postoperative hospital stay, and a shorter operative time. Laparoscopic procedures should be the first choice for treating children with congenital midureteral obstructions.

Magnetic resonance urography: a practical approach to preparation, protocol and interpretation

Magnetic resonance urography (MRU) is an important MRI application that provides noninvasive comprehensive morphological and functional evaluation of the kidneys and urinary tract. It can be used to assess congenital anomalies of the kidney and urinary tract, which often present as urinary tract dilation. In children, MRU allows for high tissue contrast and high spatial resolution without requiring ionizing radiation. Magnetic resonance urography requires patient preparation in the form of pre-examination intravenous hydration, placement of a urinary catheter, and the administration of diuretics at the time of the exam. The imaging protocol is based on T2-weighted images for anatomical assessment and dynamic post-contrast images for functional evaluation. These images are then used to generate quantitative and graphic results including contrast transit and excretion time as well as to calculate differential renal function. This review focuses on a simple approach to pediatric MRU acquisition and interpretation based on clinical cases and the authors' experience.