Congenital Midureteral Stricture Research Articles

Congenital mid-ureteral stricture: a case report of two patients

BackgroundCongenital hydronephrosis is a common foetal anomaly. There are numerous causes of hydronephrosis. The diagnosis of ureteral anomalies remains challenging. Congenital mid-ureteral stricture (CMS) is less common than proximal and distal strictures. In most cases involving CMS, this condition is diagnosed intra-operatively. The gold standard treatment is resection of the stenosed segment and ureteroureterostomy.Case presentationWe report two patients with CMS which presented as antenatal hydronephrosis with postnatal workup showed a picture of pelviuretric junction obstruction which required surgical correction. Intraoperative retrograde pyelography (RGP) confirmed the diagnosis of mid ureteral stricture which make us to change the planned surgical intervention from pyeloplasty to excision of the ureteral stricture and ureteroureterostomy as definitive management.ConclusionCMS should be considered whenever proximal mega-ureter is an associated finding. Despite advanced radiological modalities, RGP remains the mainstay approach for diagnosing ureteral anomalies.

Laparoscopic Resection and End-to-End Ureteroureterostomy for Midureteral Obstruction in Children.

Midureteral obstruction is an extremely rare condition. This retrospective study assessed the outcomes of laparoscopic ureteroureterostomy (UU) in 13 children with midureteral obstructions. Records of patients with midureteral obstruction who underwent laparoscopic end-to-end UU between July 2011 and August 2015 were reviewed. The medical records comprised patient demographic data, intraoperative details, postoperative outcomes, and related complications. Renal ultrasound, magnetic resonance urography, and radioisotope renography were used for pre- and postoperative assessment. Success was defined as removal of symptomatic obstruction or improvement of hydronephrosis. Thirteen patients from 3.0 months to 12 years old were identified: 6 patients presented with asymptomatic hydronephrosis (according to the renal ultrasonography), 3 with intermittent abdominal pain, and 2 with gross hematuria. The remaining 2 patients presented with urinary extravasation after inguinal hernia repair and the Soave procedure, respectively. All patients underwent laparoscopic end-to-end UU. Procedures were performed using either the laparoscopic transperitoneal approach or laparoscopic retroperitoneal approach. All surgeries were performed successfully except for one case that required open surgery because of difficult anastomosis. There were no intraoperative or immediate postoperative complications. The etiology of the midureteral obstruction included congenital midureteral stricture, ureteral polyp, retrocaval ureter, and iatrogenic injury. The mean surgical time was 148.4 min, and postoperative hospital stay was 4.0-9.0 d. Postoperative outcomes were successful in all 13 patients (100%); median follow-up was 19.1 months. Laparoscopic UU was found to be feasible and safe for the management of midureteral obstruction in children.

Clinical characteristics and outcomes of congenital midureteral stricture detected by fetal ultrasonography

Congenital midureteral stricture (CMS), which develops from obstructive lesion between pyeloureteral junction and ureterovesical junction, is relatively rare and its clinical condition and therapeutic strategy have not yet been established. We analyzed the clinical characteristics and surgical outcomes of CMS. From November 2006 to December 2012, out of 137 patients presented with congenital hydrohephrosis, we identified 4 pediatric patients diagnosed with CMS at our institutions. We retrospectively investigated clinical characteristics and surgical outcomes in these 4 patients. Three boys and one girl were identified in this study. All patients were detected hydronephrosis by fetal ultrasonography. The median age at the diagnosis of CMS was 1 year and 11 months. Three patients had obstructive lesion in left side and 1 patient in right. CMSs were located at the level of L4 in 2 patients, and at the level of L5 and S1 in each 1. Split renal function was decreased less than 45% in 3 of 4 patients. Ipsilateral pyeloureteral junction obstruction and ipsilateral hypoplastic kidney were identified in 2 and 1 patient, respectively. One patient developed urosepsis and underwent nephrostomy. Partial ureterectomy and ureteroureterostomy, pyeloplasty were performed in 3 and 1 patient, respectively. Extrinsic obstruction was detected in just 1 patient intraoperatively. In all patients, there were no protruded lesion and atrophied, fibrotic and ischemic muscles were not detected in pathological finding. Neither urinary tract infection nor recurrence of obstructive lesion was detected in all patients at the mean follow-up period of 3 years and 1 month. We analyzed the clinical characteristics of 4 pediatric patients with CMS. In order to prevent critical infection and maintain renal function, it could be considered that surgical intervention is undertaken just after making the diagnosis of CMS.

Robot-Assisted Laparoscopic Excision and Ureteroureterostomy for Congenital Midureteral Stricture

Congenital ureteral strictures most commonly occur at the proximal and distal segments of the ureter. Congenital midureteral stricture is a rare entity that is usually detected by prenatal ultrasonography and repaired in infants. We present the case and video of a congenital midureteral stricture in a 20-year-old woman who presented with a severe episode of pyelonephritis. The congenital midureteral stricture was successfully managed with robot-assisted laparoscopic excision and ureteroureterostomy.

Midureteral Hypoplasia at Congenital Midureteral Stricture

Hydronephrosis is the most common abnormal finding of genitourinary tract detected by fetal ultrasonography. The causes of majority are attributed to ureteropelvic junction(UPJ) obstruction. The remaining are secondary to vesicoureteral reflux, megaureter, or posterior urethral valves. Congenital midureteral stricture is an unusual cause of hydronephrosis. We report a case in a one month old male baby with hydronephrosis(grade V, 20mm in AP diameter). He was diagnosed as a ureteropelvic junction obstruction. A mid ureteral stricture was identified with intraoperative anterograde pyelography. After removal of severely strictured ureter, the dilated proximal end was anastomosed to the spatulated distal ureter by microscope. Pathologic finding was subepithelial fibrosis and segmental inner smooth muscle attenuation. Ureteral stent was removed 2 months after surgery. Degree of hydronephrosis was markedly reduced on the follow up ultrasonography(14mm in AP diameter) 6 months after surgery. (Korean J Urol 2008;49:570-573)

Prenatal diagnosis of a rare form of congenital mid-ureteral stricture: a case report and literature revisited

BackgroundCongenital mid-ureteral stricture is a rare malformation of the ureter leading to prenatal and neonatal hydronephrosis. Site characterization of the narrowing is important to optimize the surgical approach to the newborn affected by hydronephrosis.Case presentationWe report a female EM with a rare form of hydronephrosis, (i.e. mid-ureteral stricture) which was detected early during pregnancy by imaging techniques. During fetal life both conventional fetal Ultrasound and maternal Magnetic Resonance Imaging (MRI) were used to diagnose the obstruction. Magnetic Resonance pyelography and retrograde Ureteropyelography were performed after delivery and before surgical correction and confirmed the finding.Furthermore, we revisited the literature using online MEDLINE and EMBASE databases. The literature reported only a few cases of prenatal diagnosis of early onset mid-ureteral stricture.ConclusionMid-ureteral stricture is a rare cause of prenatal hydronephrosis. The diagnosis should not be delayed in order to apply the appropriate surgical approach. As a result, we showed the usefulness of fetal MRI and postnatal Magnetic Resonance pyelography, in the event that radionuclide renography with Tc-MAG3 was less informative, to allow the detection of the site of ureteral narrowing. Intrasurgical retrograde ureteropyelography confirmed these findings.

Bilateral congenital midureteric stricture

Midureteric stricture is a rare cause of congenital hydronephrosis. Its etiology and pathophysiology is uncertain. We report a case of an 8 year old male child who presented with recurrent urinary tract infections and moderate renal impairment. Sonar revealed bilateral hydronephrosis. This was confirmed to be due to intrinsic midureteric narrowing on MRU. Bilateral ureteric exploration confirmed these findings and uretero-ureterostomy was performed. Postoperative imaging showed improvement in hydronephrosis. We review the published literature. CASE REPORT An 8 year old boy was admitted to our institution with a documented UTI. He had no significant past medical history. Physical examination was non-contributory. He was in moderate renal impairment with a serum Creatinine of 130mmol/l and an estimated Creatinine Clearance, using the Schwartz formula, of 50ml/min/m?. Urine cultures for Tuberculosis were negative. Renal sonar revealed gross bilateral hydroureteronephrosis with thin renal cortices. The bladder appeared normal. Of note no ureteric dilatation was seen at the level of the bladder. An MCUG revealed a normal bladder and posterior urethra with no reflux. Radioisotopic mercaptoacetyltriglycine (MAG3) renography showed poor uptake bilaterally with apparent holdup at the midureteric level. In view of the unusual imaging and to exclude extrinsic retroperitoneal pathology a Gadolinium enhanced magnetic resonance urogram was requested. This showed no retroperitoneal pathology, but bilateral midureteric obstruction. (See Figure 1). Figure 1 Figure 1: Gadolinium enhanced magnetic resonance urogram demonstating midureteric obstruction. Retrograde pyelograms revealed a tight, short-segment, nonnegotiable stricture at the level of the pelvic brim bilaterally. (Figure 2) Bilateral congenital midureteric stricture 2 of 3 Figure 2 Figure 2: Left retrograde pyelogram showed a pelvic brim stricture. Bilateral extraperitoneal ureteric exploration was performed using a Gibson incision. On both sides a similar appearance was seen. The stricture was excised revealing a pin-hole lumen. No valves or polyps were noted intraluminally. Stented ureter-ureterostomy was performed without tapering. The child made an uneventful recovery. Followup sonar at 3 months showed improvement in hydronephrosis bilaterally. Pathological review revealed proximal dilatation with nonspecific thickening of the muscular wall. Electron microscope evaluation of the strictured area showed no specific ultrastructural abnormality. DISCUSSION Congenital midureteric stricture is an uncommon cause of hydronephrosis in children. Less than 20 pathologically confirmed cases are reported in the literature. (2) The diagnosis may be confused with ureteropelvic or ureterovesical junction obstruction. Hence, retrograde pyelography is essential in the management of this anomaly. The differential diagnosis must additionally include ureteral valves and fibroepithelial polyps. Ectopic ureter and contralateral renal agenesis have been associated with some of the published cases. (2,4) The bilateral nature of our case would lend support to Kropp's assertion that contalateral agenesis and bilaterality point to the manifestation of a similar pathological process in this condition. (2) The cause of congenital midureteric stricture, however, remains unknown. Docimo postulated a variety of etiologic possibilities: 1) improper ureteric recanalisation, 2) insufficient vascular supply, 3) persistent ureteric folds, 4) ureteric bud anomalies. (3) It has been postulated that this condition runs a more aggressive natural history than other causes of congenital hydronephrosis. (2) This feature is born out by our case where longstanding obstruction resulted in renal impairment.

Severe congenital midureteral dilatation

Congenital midureteral stricture is an uncommon cause of prenatal hydronephrosis, and it is generally associated with proximal hydroureteronephrosis [1,2]. We report a unique case of a congenital severe midureteral dilatation associated with mild proximal ureteral dilatation and normal distal ureteral diameter. The dilated midureter was excised, and an open end-to-end ureteroureterostomy was performed. Follow-up 6 months after surgical correction revealed marked improvement in the left-sided hydronephrosis and complete resolution of the hydroureter.

CONGENITAL MID URETERAL STRICTURES

Congenital mid ureteral stricture is rare. We report 7 cases, and discuss the differences in preoperative evaluation and surgical management compared to other obstructive entities. Medical records and imaging studies of 7 children identified with mid ureteral strictures between 1998 and 2002 were reviewed retrospectively. Five newborns presented with prenatal hydronephrosis, and 2 children presented at age 15 years, one in the course of evaluation of blunt trauma, and one due to pain and abdominal mass. Imaging studies included renal ultrasound, voiding cystourethrography, radionuclide renography and computerized tomography. All patients underwent retrograde pyelography. Pathological examination of each specimen was undertaken at the respective institutions. Prenatal hydronephrosis was the most common presentation. There were no urinary tract infections. All patients had significant obstruction on the affected side. No patient had vesicoureteral reflux. After imaging but before surgery the urinary obstruction was believed to be at the ureteropelvic junction in 4 patients and the ureterovesical junction in 2, and secondary to posterior urethral valves in 1. At cystoscopy all of the affected ureters had a normally located and normally configured orifice. Retrograde pyelography led to an accurate diagnosis of mid ureteral narrowing in all patients. Six patients underwent ureteroureterostomy, all of whom had satisfactory outcomes. In 1 of these patients contralateral nephrectomy was performed due to nonfunction of the multicystic dysplastic kidney. The remaining patient underwent nephrectomy for ipsilateral end stage kidney disease and hydronephrosis. In this patient the ureters were stenotic and suggested asymmetry in the thickness of the muscular coat, perhaps secondary to extrinsic compression. Congenital mid ureteral stricture is rare. Renal ultrasound and radionuclide renography alone do not reliably demonstrate the site of obstruction. Retrograde pyelography at the time of surgical correction of presumed ureteral obstruction is an important adjunct for correctly identifying the site of narrowing in the affected ureteral segment, unless the ureter has been imaged with another modality.

Laparoscopic Resection and Ureteroureterostomy for Congenital Midureteral Stricture

A 16-year-old boy presented with flank pain and was found to have right-sided hydronephrosis and hydroureter on ultrasonography and an intravenous urogram. A retrograde pyelogram revealed a tight, short-segment, non-negotiable stricture in the midureter. A CT scan excluded extrinsic compression. In the absence of any other pathology, the stricture was considered to be congenital. The diseased segment of the ureter was resected laparoscopically, and an intracorporeally sutured ureteroureterostomy was fashioned over a double- J stent. The patient made an uneventful recovery and was well at follow-up 18 months later. To the best of our knowledge, this is the first reported case of laparoscopic resection of a congenital midureteral stricture.

Congenital midureteral stricture in children diagnosed with antenatal hydronephrosis

ObjectivesAntenatal hydronephrosis is the most common genitourinary pathologic finding during gestational ultrasonography. Congenital midureteral strictures are an unusual cause of prenatal hydronephrosis, with 13 total previously reported and only 1 diagnosed as a result of antenatal ultrasonography. MethodsWe present 4 cases of midureteral strictures as the cause of antenatal hydronephrosis and review the published data on congenital midureteral obstruction. ResultsAll midureteral strictures in our series and in the published reports were treated surgically after varying periods of observation. Retrograde pyelography was diagnostic in all cases. ConclusionsThis atypical cause of antenatal hydronephrosis may provide additional insight into the controversy regarding preoperative retrograde pyelography before surgical intervention for ureteropelvic junction obstruction. Given the typical misdiagnosis of ureteropelvic junction obstruction in the setting of midureteral stricture disease, we believe that the threshold for retrograde pyelography should be very low.

Congenital Mid Ureteral Stricture Presenting As Prenatal Hydronephrosis

No AccessJournal of UrologyPEDIATRIC UROLOGY: SOCIETY FOR FETAL UROLOGY1 Sep 2002Congenital Mid Ureteral Stricture Presenting As Prenatal Hydronephrosis Jordan Gitlin and Martin Kaefer Jordan GitlinJordan Gitlin More articles by this author and Martin KaeferMartin Kaefer More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64615-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Congenital Mid Ureteral Stricture Presenting As Prenatal Hydronephrosis." The Journal of Urology, 168(3), pp. 1154–1155 References 1 : A study on fetal urinary tract anomaly: antenatal ultrasonographic diagnosis postnatal follow up. J Obstet Gynaecol Res1996; 22: 569. Crossref, Medline, Google Scholar 2 : Congenital midureteral strictures. Urology1985; 26: 170. Crossref, Medline, Google Scholar 3 : Congenital midureteral obstruction. Urol Radiol1989; 11: 156. Crossref, Medline, Google Scholar From Riley Children’s Hospital, Indianapolis, Indiana© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Meng Z, Lin D, Wang G, Qu Y and Sun N (2021) Congenital midureteral stenosis in children: a 13-year retrospective study based on data from a large pediatric medical centerBMC Urology, 10.1186/s12894-021-00916-2, VOL. 21, NO. 1, Online publication date: 1-Dec-2021. Starosta S and Stec A (2019) Robot-assisted laparoscopic midureteral stricture repair and percutaneous stent placement in an infantJournal of Pediatric Urology, 10.1016/j.jpurol.2019.03.024, VOL. 15, NO. 3, (289-290), Online publication date: 1-May-2019. Hamid R, Bhat N and Rashid K (2015) Congenital Midureteric Stricture: Challenges in Diagnosis and ManagementCase Reports in Urology, 10.1155/2015/969246, VOL. 2015, (1-5), . Arlen A, Kirsch A, Cuda S, Little S, Jones R, Grattan-Smith J and Cerwinka W (2014) Magnetic resonance urography for diagnosis of pediatric ureteral strictureJournal of Pediatric Urology, 10.1016/j.jpurol.2014.01.004, VOL. 10, NO. 5, (792-798), Online publication date: 1-Oct-2014. Ogihara K, Yazawa S, Asanuma H, Takamatsu K, Masuda A, Yasumizu Y, Sato H, Matsui Z, Muramatsu M, Kono H, Mizuno R and Oya M (2014) CLINICAL CHARACTERISTICS AND OUTCOMES OF CONGENITAL MIDURETERAL STRICTURE DETECTED BY FETAL ULTRASONOGRAPHYThe Japanese Journal of Urology, 10.5980/jpnjurol.105.122, VOL. 105, NO. 3, (122-128), . Grattan-Smith J, Jones R, Little S and Kirsch A (2010) Bilateral congenital midureteric strictures associated with multicystic dysplastic kidney and hydronephrosis: evaluation with MR urographyPediatric Radiology, 10.1007/s00247-010-1799-z, VOL. 41, NO. 1, (117-120), Online publication date: 1-Jan-2011. Kannaiyan L, Karl S, Mathai J, Chacko J and Sen S (2009) Congenital ureteric stenosis: a study of 17 childrenPediatric Surgery International, 10.1007/s00383-009-2368-0, VOL. 25, NO. 6, (513-517), Online publication date: 1-Jun-2009. Domenichelli V, De Biagi L, Italiano F, Carfagnini F, Lavacchini A and Federici S (2008) Congenital bilateral mid-ureteral stricture: A unique caseJournal of Pediatric Urology, 10.1016/j.jpurol.2008.01.214, VOL. 4, NO. 5, (401-403), Online publication date: 1-Oct-2008. Brugnara M, Cecchetto M, Manfredi R, Zuffante M, Fanos V, Pietrobelli A and Zaffanello M (2007) Prenatal diagnosis of a rare form of congenital mid-ureteral stricture: a case report and literature revisitedBMC Urology, 10.1186/1471-2490-7-8, VOL. 7, NO. 1, Online publication date: 1-Dec-2007. Daher P, Riachy E, Mourani C, Smayra T and Haddad S (2007) An unusual case of bilateral primitive obstructed megaureters due to ureteral valves presenting with anuria at the age of 1 monthJournal of Pediatric Surgery, 10.1016/j.jpedsurg.2007.08.047, VOL. 42, NO. 11, (e17-e20), Online publication date: 1-Nov-2007. Prieto J, Castellan M, Gosalbez R, Labbie A and Perez-Brayfield M (2007) Severe congenital midureteral dilatationJournal of Pediatric Surgery, 10.1016/j.jpedsurg.2006.09.063, VOL. 42, NO. 1, (257-258), Online publication date: 1-Jan-2007. Nouira Y, Feki W, Kallel Y, Mekni A, Haouet S and Horchani A (2006) Les valves de l'uretère : à propos de deux observationsAnnales de Chirurgie, 10.1016/j.anchir.2006.03.021, VOL. 131, NO. 9, (567-570), Online publication date: 1-Nov-2006. HWANG A, McALEER I, SHAPIRO E, MILLER O, KROUS H and KAPLAN G (2018) CONGENITAL MID URETERAL STRICTURESJournal of Urology, VOL. 174, NO. 5, (1999-2002), Online publication date: 1-Nov-2005. 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Volume 168Issue 3September 2002Page: 1154-1155 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsureterureteral obstructionprenatal diagnosisMetricsAuthor Information Jordan Gitlin More articles by this author Martin Kaefer More articles by this author Expand All Advertisement PDF downloadLoading ...

Congenital Mid Ureteral Stricture Presenting As Prenatal Hydronephrosis

Congenital Mid Ureteral Stricture Presenting As Prenatal Hydronephrosis

End-to-end Ureteral Anastomosis in Children With Congenital Mid-Ureteral Stricture

End-to-end Ureteral Anastomosis in Children With Congenital Mid-Ureteral Stricture

Congenital Mid-Ureteral Stricture in a Solitary Kidney

No AccessJournal of Urology1 Oct 1971Congenital Mid-Ureteral Stricture in a Solitary Kidney Bernard Kosto Bernard KostoBernard Kosto More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)61333-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1971 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHWANG A, McALEER I, SHAPIRO E, MILLER O, KROUS H and KAPLAN G (2018) CONGENITAL MID URETERAL STRICTURESJournal of Urology, VOL. 174, NO. 5, (1999-2002), Online publication date: 1-Nov-2005.Dewolf W, Fraley E and Markland C (2018) Congenital Hypoplasia of the Proximal UreterJournal of Urology, VOL. 113, NO. 2, (236-237), Online publication date: 1-Feb-1975. Volume 106Issue 4October 1971Page: 529-531 Advertisement Copyright & Permissions© 1971 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Bernard Kosto More articles by this author Expand All Advertisement PDF downloadLoading ...