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

Abstract

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.

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

“…Studies of the ultrastructure of ureteral stricture revealed that the stenotic ureter exhibits only quantitative changes in its composition. These changes included lumen shrinkage and relative or absolute loss of smooth muscle with a normal, altered, or disorganized arrangement, with or without connective tissue changes 10–12 . In our case, pathological examination revealed that the area of ureteral stricture was thickened due to hyperplasia of fibrous connective tissue and that the smooth muscle tissue and nerve fibers remained.…”

Double trouble: diagnostic dilemma in a rare association of proximal ureteric valve with orthotopic ureterocele—case report

“…More recently, several authors have directed attention to the frequent occurrence of associated ureteral anomalies in conjunction with ureteral valves. This is evidence that neither the fetal fold theory nor the Chwalle's membrane theory adequately explain ureteral valves and that the ureteral anomaly association points to a more generalized disturbance of ureteral bud development [2,5,9].…”

“…Since the initial description by Wolfler in 1877, till date, only 65 cases of ureteric valves have been reported [3,4]. Rabinowitz has classified ureteric valves as Type I or Type II, based on the presence of smooth muscle within the leaflet or at the base only [5]. Morphologically, ureteric valves can be classified as cusp-like (leaflet) and diaphragmatic or annular type [1].…”

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

“…The pathogenesis of this condition is unclear, and many theories attribute it to abnormal embryonic development, including abnormal fetal vessel compression, intrauterine inflammation, incomplete ureteral recanalization, ischemia due to abnormal branches of blood vessels and localized developmental arrest [ 1 – 5 ]. A review of the previous literature has revealed that in children, congenital midureteral stenosis is often associated with urological anomalies, such as contralateral renal agenesis or atrophy, VUR, UPJO, crossed renal ectopia, solitary kidney and contralateral blind-ending ureter [ 6 – 8 ], suggesting the possibility of bilateral aberrant renal and ureteral development and indicating that ureteral stenosis may be a mild manifestation of unilateral hypoplasia. In the present study, one case of contralateral MCDK with systemic growth retardation and two cases of contralateral renal axis malrotation were found.…”

“…Studies on the ultrastructure of ureteral stenosis found that the stenotic ureter did not deviate fundamentally from its pattern, and only quantitative changes in its composition were observed. These changes included lumen shrinkage and relative or absolute loss of smooth muscle with a normal, altered or disorganized arrangement, with or without connective tissue changes [ 1 – 8 ]. Our pathological specimens exhibited smooth muscle hyperplasia and fibrous tissue degeneration.…”