Korean J Urol.  2008 Jun;49(6):570-573.

Midureteral Hypoplasia at Congenital Midureteral Stricture

• Oh JJ
• Jang WG
• Jee SH
• Hong YK

Abstract

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.

Keyword

Prenatal hydronephrosis; Midureteral stricture

MeSH Terms

Constriction, Pathologic
Fibrosis
Follow-Up Studies
Humans
Hydronephrosis
Male
Muscle, Smooth
Stents
Ultrasonography, Prenatal
Ureter
Urography
Vesico-Ureteral Reflux

Figure

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  Fig. 1. Preoperative renal ultrasonography. Severe hydronephrosis is noted in the left kidney, measuring 20mm in AP diameter.

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  Fig. 2. Preoperative diuretic renogram. Severe hydronephrosis of left kidney with poor reaction to diuretics.

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  Fig. 3. Intraoperative anterograde pyelography. Arrow indicates an abrupt narrowing of ureter.

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  Fig. 4. Pathologic finding showing subepithelial fibrosis and segmental inner smooth muscle attenuation.

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  Fig. 5. Postoperative renal ultrasonography. Decreased hydronephrosis of left kidney with 14mm in AP diameter.

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