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

Abstract

Background Midureteral stenosis is very rare in children and can cause congenital hydronephrosis. We report our experience treating children with congenital midureteral stenosis at our center, focusing on the differences in preoperative diagnosis and treatment compared with other congenital obstructive uropathies. Methods We retrospectively reviewed the medical records of 26 children diagnosed with congenital midureteral stenosis at our center between January 2007 and December 2020, such as preoperative examination methods, intraoperative conditions, and postoperative follow-up results. Results Of the 1625 children treated surgically for ureteral narrowing, only 26 (1.6%) were diagnosed with midureteral stenosis, including 15 infants and 11 children. Eighteen (69.2%) were boys, 13 (50%) were affected on the left side, and 23 (88.5%) had isolated ureteral stenosis. Overall, 13 (50%) of the children presented with prenatal hydronephrosis, and 13 (50%) presented with abdominal pain or a mass. All the children had undergone urinary ultrasound and intravenous urography preoperatively; the diagnostic rate of ultrasound was 92.3%. Only 7 (26.9%) children had undergone pyelography. All the children had undergone surgery. The ureteral stenotic segment was less than 1 cm long in 25 (96.2)% of the children. The mean follow-up duration was 22 months (range: 6–50 months). One child developed anastomotic strictures. Urinary tract obstruction was relieved in the other children without long-term complications. Conclusions Congenital midureteral stenosis is rare, accounting for 1.6% of all ureteral obstructions, and its diagnosis is crucial. Urinary ultrasound has a high diagnostic rate and should be the first choice for midureteral stenosis. Retrograde pyelography can be used when the diagnosis is difficult, but routine retrograde pyelography is not recommended. Congenital ureteral stenosis has a relatively short lesion range, largely within 1 cm. The treatment is mainly resection of the stenotic segment and end-to-end ureteral anastomosis, with a good prognosis.

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

“…Hwang reported in an autopsy of a sequence of 12 080 children that 72 children had ureteral strictures and only three children (4%) had mid‐ureteral stricture 7 . Meng reported in a study that the incidence of mid‐ureteral stricture was in 26 patients (1.6%) in 1625 children who underwent surgical treatment for obstructive hydroureter over the past 13 years 8 . Congenital mid‐ureteral stricture in children can be accompanied by urological abnormalities such as agenesis or atrophy of the contralateral kidney, VUR, ureteropelvic junction obstruction, crossed renal ectopia, solitary kidney, and contralateral cecum ureter 9–11 .…”

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

“…Most recently, Meng et al. reported that middle ureteral stricture accounts for only 1.6% of all ureteral strictures 2 …”

“…1 Most recently, Meng et al reported that middle ureteral stricture accounts for only 1.6% of all ureteral strictures. 2 Mid-ureteral stricture occurs at the level of the bifurcation of the common iliac vessels. Previous literature has shown that the ureteral lumen is shrunken by around 60% at the stricture site, resulting in a significant obstruction to urine delivery.…”

“…3 Meng et al reported that children with mid-ureteral stricture had relatively mild hydronephrosis and delayed onset of symptoms. 2 Few studies have reported on mid-ureteral stricture diagnosed at 15 and 20 years of age. 4,5 Hawang et al reported that renal ultrasound and radionuclide renography alone do not suffice to identify the site of stricture, and that preoperative RP should be performed to identify the stricture site unless the distal ureter is well confirmed by other tests.…”

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

“…Although open ureteroureterostomy is an effective method for surgical correction of ureteral obstruction [ 4 , 5 ], it may involve a larger surgical wound [ 3 ]. With the breakthrough of minimally invasive technology, laparoscopic ureteral reconstruction has occasionally been reported in the treatment of patients with CMO [ 2 , 6 – 8 ]. Nezhat et al first reported a case of adult laparoscopic ureteroureterostomy for ureteral obstruction in 1992 [ 7 ].…”