Hypothesis on etiopathogenesis, congenital or acquired, of an imperforate distal ureter: a case report.

Vincenzo Bagnara,P Caione,S Castorina,T Luca,G Privitera,S Gerocarni Nappo

doi:10.1186/s13256-015-0711-8

Abstract

IntroductionUreteral atresia is a rare disease usually associated with a non-functioning kidney. Its association with other urinary anomalies is rare.Case presentationIn this study we discuss the possibility of congenital or acquired etiology of a right imperforate distal ureter. Here we report the case of 11-month-old white boy with a right ureteropelvic junction obstruction. He underwent a right pyeloplasty when he was 11-months old, and 3 weeks after surgery a cystoscopy was performed. Two months after the first operation, he underwent a right ureteral meatoplasty and a new pyeloplasty.ConclusionsTo the best of our knowledge, few cases of imperforate distal ureter have been described in the literature. The suspicion of a non-patent terminal ureter, occurring during upper urinary tract surgery, must be intraoperatively clarified to preserve the renal function and to avoid more complex surgical approaches.

Highlights

Ureteral atresia is a rare disease usually associated with a non-functioning kidney
Ureteral atresia is often a cause of hydronephrosis, a distension and dilation of the renal pelvis and calyces caused by the obstruction of urine from the kidney
A congenital ureteral obstruction can be caused by ureteropelvic junction (UPJ) obstruction, primitive megaureter, ectopic ureter, ureterocele, intermediate ureter stenosis, ureteral valves and distal ureteral atresia [6, 7]

Summary

Introduction

Ureteral atresia is a rare congenital abnormality usually associated with a dysplastic non-functioning kidney [1]. The production of urine starts at 9 weeks of development when the ureter joins the urogenital sinus which is still obstructed by the Chwalla’s membrane. This membrane decreases during approximately the 37th to 47th days of pregnancy [2, 3]. Interpretation of imaging studies was made from the original radiologists’ reports and from the original images (Fig. 1) When he was 11-months old, he underwent Anderson-Hynes right pyeloureteroplasty. Postoperative radiographic transnephrostomic controls did not permit a view of his right ureter, probably due to anastomosis edema For this reason, 3 weeks after surgery, a JJ stent was placed by cystoscopy, but it was impossible to visualize the right ureteral meatus (Fig. 2). He is well, he grows up normally and he has had no urinary infections

Discussion

Conclusions